Vincenzo Russo

Purpose Evaluate Late Iodine Enhancement (LIE) using the new Philips Spectral CT 7500 scanner without ECG-gating. Material and Methods Fifty-one contrast-enhanced cardiac Computed Tomography (CT) scans with LIE phase (LIE-CT) acquired using the Philips Spectral CT 7500 scanner (8 cm, 256 reconstructed slices) were retrospectively reviewed. LIE-CT was acquired 6–7 min after the administration of contrast agent, using ultra-short scanning time without ECG-gating. LIE-CT technical and dosimetry data were compared with data from 17 cardiac CT scans acquired with Philips Brilliance iCT (4 cm, 128 reconstructed slices). On Spectral CT images, LIE was assessed using "Iodine no water" spectral maps and Extracellular Volume (ECV) quantification. CT findings were compared with the gold standard (Cardiac Magnetic Resonance, CMR) when available. Results Spectral CT images without ECG-gating exhibited high visual quality with minimal motion artifacts. Technical data significantly differed (p < .001) between Spectral CT and iCT: median scan time 0.69 s (interquartile range (IQR) 0.66–0.72) vs 8.02 s (IQR 7.32–8.49), median Table speed 433.2 mm/s vs 23.5 mm/s (IQR 21.8–26.5), median CTDIvol 7.2 mGy vs 29.6 mGy (IQR 27.8–33.3), median DLP 211 mGy*cm (IQR 199–222) vs 477.6 mGy*cm (IQR 430.9–551.7), current 812 mA vs 924 mA (IQR 924–925), voltage 100 kV (min 100–max 140) vs 80 kV. Interobserver reproducibility of ECV quantification on Spectral CT images was good in myocardium without LIE and excellent in LIE areas, with negligible bias between observers. Where available, LIE and ECV findings showed good concordance with CMR LGE and ECV. Conclusion Ultrafast non-ECG-gated cardiac Spectral CT provides high-quality images for evaluating LIE, 76% reduction of radiation dose, 50% increase in signal-to-noise ratio, and 91% reduction of acquisition time. ECV measurements demonstrate high interobserver reproducibility. Preliminary findings show good agreement with CMR; while based on a limited validation cohort with selective ECV use.

Purpose The purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community. Methods Between December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging. Results 557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient’s body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings. Conclusions This survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.

Https://doi.org/10.1093/eurheartj/suab135.026

Purpose: To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. Methods: Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. Results: Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. Conclusions: Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.

Cardiac magnetic resonance (CMR) imaging is an effective method for noninvasively imaging the heart which in the last two decades impressively enhanced spatial and temporal resolution and imaging speed, broadening its spectrum of applications in cardiovascular disease. CMR imaging techniques are designed to noninvasively assess cardiovascular morphology, ventricular function, myocardial perfusion, tissue characterization, flow quantification and coronary artery disease. These intrinsic features yield CMR suitable for diagnosis, follow-up and longitudinal monitoring after treatment of cardiovascular diseases. The aim of this paper is to review the technical basis of CMR, from cardiac imaging planes to cardiac imaging sequences.

The extensive use of daptomycin for treating complex methicillin-resistant Staphylococcus aureus infections has led to the emergence of daptomycin-resistant strains. Although genomic studies have identified mutations associated with daptomycin resistance, they have not necessarily provided insight into the evolution and hierarchy of genetic changes that confer resistance, particularly as antibiotic concentrations are increased. Additionally, plate-dependent in vitro analyses that passage bacteria in the presence of antibiotics can induce selective pressures unrelated to antibiotic exposure. We established a continuous culture bioreactor model that exposes S. aureus strain N315 to increasing concentrations of daptomycin without the confounding effects of nutritional depletion to further understand the evolution of drug resistance and validate the bioreactor as a method that produces clinically relevant results. Samples were collected every 24 h for a period of 14 days and minimum inhibitory concentrations were determined to monitor the acquisition of daptomycin resistance. The collected samples were then subjected to whole genome sequencing. The development of daptomycin resistance in N315 was associated with previously identified mutations in genes coding for proteins that alter cell membrane charge and composition. Although genes involved in metabolic functions were also targets of mutation, the common route to resistance relied on a combination of mutations at a few key loci. Tracking the frequency of each mutation throughout the experiment revealed that mutations need not arise progressively in response to increasing antibiotic concentrations and that most mutations were present at low levels within populations earlier than would be recorded based on single-nucleotide polymorphism (SNP) filtering criteria. In contrast, a serial-passaged population showed only one mutation in a gene associated with resistance and provided limited detail on the changes that occur upon exposure to higher drug dosages. To conclude, this study demonstrates the successful in vitro modeling of antibiotic resistance in a bioreactor and highlights the evolutionary paths associated with the acquisition of daptomycin non-susceptibility.

Coronary artery fistulas are rare congenital malformations that can originate from anywhere in the coronary artery system and terminate in any of the cardiac chambers, great veins or pulmonary arteries. We illustrate the unique case of a multidetector computed tomography coronary angiography scan of a young man, showing a complex coronary fistula between the left anterior descending coronary artery and a branch of the left pulmonary artery (with drainage function) with adjunctive mediastinic and abdominal aberrant feeding arteries arising, respectively, from the left internal mammary artery and the celiac trunk.

Article published by the Endocrine Society Article published by the Endocrine Society