Dongting Liu

Purpose: To investigate the clinical outcomes of acute Stanford type B intramural hematoma (TBIMH) without ulcer-like lesions following medical management and to identify predictors of disease progression. Materials and Methods: A retrospective analysis was performed on patients with acute TBIMH without ulcer-like lesions who received medical management. Patients were categorized into progression and nonprogression groups based on 1-year follow-up computed tomography angiography (CTA). Disease progression was defined as aortic rupture, aortic dissection, aortic enlargement (≥5 mm), or hematoma thickening (≥3 mm), while nonprogression was defined as complete/partial resolution or retention of the hematoma. A multivariate analysis identified the predictors of disease progression, and Kaplan-Meier curves were used to compare survival outcomes. Results: A total of 110 patients (mean age 55.9±10.5 y, 25 females) were included, with 21 patients (19.1%) showing disease progression. Multivariate analysis revealed that the maximum aortic diameter (MAD) (OR=7.6, P =0.003) and maximum CT value of the hematoma (CTmax) (OR=1.04, P =0.025) were independently associated with disease progression. The optimal cutoff values for MAD and CTmax were 40.0 mm (AUC: 0.69, sensitivity: 38.1%, specificity: 92.1%) and 71.9 HU (AUC: 0.68, sensitivity: 76.2%, specificity: 66.3%), respectively. When MAD and CTmax were combined, the AUC increased to 0.75 (sensitivity: 81.0%, specificity: 66.3%). Conclusion: A model based on MAD and CTmax effectively stratifies progression risk in TBIMH without ulcer-like lesions, facilitating early intervention in high-risk patients.

The ectopic thyroid gland is an abnormal development of the embryo. Most of the ectopic thyroid occurs in the path around the thyroglossal duct or on the lateral side of the neck. However, ectopic thyroid occurs in the heart, which is rare. We report a case of right ventricular ectopic thyroid. This case highlights the imaging characteristics of computed tomography (CT) and cardiac magnetic resonance (CMR) and discusses the underlying mechanisms for a timely diagnosis.

The ectopic thyroid gland is an abnormal development of the embryo. Most of the ectopic thyroid occurs in the path around the thyroglossal duct or on the lateral side of the neck. However, ectopic thyroid occurs in the heart, which is rare. We report a case of right ventricular ectopic thyroid. This case highlights the imaging characteristics of computed tomography (CT) and cardiac magnetic resonance (CMR) and analyzes the underlying mechanisms for a timely diagnosis.

To assess the variation in left atrial (LA) and biventricular strain and its prognostic value in the course of suspected myocarditis, this retrospective study included 55 patients with clinically suspected myocarditis who underwent cardiac magnetic resonance (CMR) examinations at baseline and follow-up periods. Cine images were used for feature tracking analysis. Paired Student’s t test, McNemar’s test, and Cox proportional hazard regression were used for statistical analysis. The LA total emptying fraction was the only functional index that showed a statistically significant improvement. The initial LA peak’s late negative strain rate (SRa) was the only parameter with a significant predictive power of major adverse cardiac events under univariable (hazard ratio [HR] 2.396, 95% confidence interval [CI] 1.044–5.498, p = 0.039) and multivariable Cox survival analysis when adjusted by LA strain parameters (HR 5.072, 95% CI 1.478–17.404, p = 0.010), LA strain and functional parameters (HR 7.197, 95% CI 1.679–30.846, p = 0.008), and LA and biventricular strain and functional parameters (HR 10.389, 95% CI 2.250–47.977, p = 0.003). Thus, our findings indicate that CMR strain is useful for monitoring LA and ventricular function in suspected myocarditis, that LA function may recover preceding ventricular function changes, and that LA strain may serve as an incremental tool to predict adverse outcomes.

Type 2 diabetes mellitus (T2DM) is associated with a high prevalence of diastolic dysfunction and congestive heart failure. A potential contributing factor is the accelerated accumulation of diffuse myocardial fibrosis and stiffness. Novel cardiac magnetic resonance (CMR) imaging techniques can identify both myocardial fibrosis and contractility quantitatively. This study aimed to investigate the dynamic characteristics of the myocardial strain and altered extracellular volume (ECV) fraction as determined by 7.0 T CMR in T2DM mice. C57Bl/6J mice were randomly divided into T2DM (fed a high-fat diet) and control (fed a normal diet) groups. They were scanned on 7.0 T MRI every 4 weeks until the end of week 24. The CMR protocol included multi-slice cine imaging to assess left ventricle strain and strain rate, and pre- and post-contrast T1 mapping images to quantify ECV. The ECV in the T2DM mice was significantly higher (p < 0.05) than that in the control group since week 12 with significantly impaired myocardial strain (p < 0.05). A significant linear correlation was established between myocardial strain and ECV (p < 0.001) and left ventricular-ejection fraction and ECV (p = 0.003). The results suggested that CMR feature tracking-derived myocardial strain analysis can assess functional abnormalities that may be associated with ECM alterations in diabetic cardiomyopathy, contributing to the study of diabetic therapy effects.

Background: Primary cardiac angiosarcoma is a rare malignancy with high predilection to involve surrounding structures such as pulmonary metastases. We analysed the chest computed tomography (CT) imaging features of patients diagnosed with primary cardiac angiosarcoma with pulmonary metastases in this study. Methods: This study retrospectively reviewed 12 patients with confirmed primary cardiac angiosarcoma, out of which eight (all men) with pulmonary metastasis were included in the analysis. The patients’ age ranged from 17 to 74 (mean: 48) years. CT was performed in all patients with unenhanced, contrast-enhanced, and both scans were done in 1, 3 and 4 patients, respectively. Results: Nodular lesions were observed in 7 patients with multiple solid nodules observed in 6 out of 7 patients. A solitary solid nodule was found in the remaining patient in the upper lobe and apical segment of the right lung with a diameter of 11.7 mm. All solid nodules were distributed along with bronchovascular bundles in the lungs, and their maximum diameter ranged from 2.3 to 19.9 mm. Nodules larger than 10 mm in diameter were heterogeneously enhanced on contrast-enhanced CT images (5/8 patients), whereas those smaller than 10 mm were homogeneously enhanced (3/8 patients). Other imaging features, namely the tree-in-bud pattern, emphysema, pleural effusion, and mediastinal lymph node enlargement, were observed in 4, 3, 3, and 2 patients, respectively. Conclusion: CT enhancement features of pulmonary metastasis in patients with primary cardiac angiosarcoma depend on the size of pulmonary nodules, with larger ones being heterogeneous and smaller ones homogeneous. Other signs are less noticed.

This study aims to explore computed tomography (CT) and magnetic resonance imaging (MRI) features of patients diagnosed with primary cardiac angiosarcoma. The study involved the analysis of 12 patients diagnosed with primary cardiac angiosarcoma who underwent non-contrast (8/12) or contrast-enhanced CT (10/12) or MRI (4/12). Imaging appearances, including the tumor location and adjacent infiltration, were analyzed. All 12 lesions were located in the right atrium with a broad base. Adjacent invasion including the tricuspid valve and right ventricle (2/12), inferior or superior vena cava (2/12), pericardium (10/12), and right coronary artery (7/12) was common. On unenhanced CT scans, tumors in two patients were homogeneous in density, whereas the others were inhomogeneous. Ten patients showed heterogeneous enhancement. The enhancement pattern showed no direct correlation with the differentiation degree of the tumor. Four lesions manifested as heterogeneous intensity, with hyperintense hemorrhage foci on both T1- and T2-weighted MRI. Three showed rim enhancement and one showed patchy enhancement. Primary cardiac angiosarcoma often involves the right side of the heart with infiltration of peripheral structures. CT features include typical inhomogeneous density on unenhanced scans and heterogeneous centripetal enhancement on enhanced scans. A cauliflower-like appearance on both T1- and T2-weighted MRI is common. The characteristic enhancement pattern of MRI remains to be determined.

The aim of this systematic review is to analyse current literature related to the clinical value of three-dimensional (3D) printed models in renal disease. A literature search of PubMed and Scopus databases was performed to identify studies reporting the clinical application and usefulness of 3D printed models in renal disease. Fifteen studies were found to meet the selection criteria and were included in the analysis. Eight of them provided quantitative assessments with five studies focusing on dimensional accuracy of 3D printed models in replicating renal anatomy and tumour, and on measuring tumour volume between 3D printed models and original source images and surgical specimens, with mean difference less than 10%. The other three studies reported that the use of 3D printed models significantly enhanced medical students and specialists’ ability to identify anatomical structures when compared to two-dimensional (2D) images alone; and significantly shortened intraoperative ultrasound duration compared to without use of 3D printed models. Seven studies provided qualitative assessments of the usefulness of 3D printed kidney models with findings showing that 3D printed models improved patient’s understanding of renal anatomy and pathology; improved medical trainees’ understanding of renal malignant tumours when compared to viewing medical images alone; and assisted surgical planning and simulation of renal surgical procedures with significant reductions of intraoperative complications. The cost and time associated with 3D printed kidney model production was reported in 10 studies, with costs ranging from USD$100 to USD$1,000, and duration of 3D printing production up to 31 h. The entire process of 3D printing could take up to a few days. This review shows that 3D printed kidney models are accurate in delineating renal anatomical structures and renal tumours with high accuracy. Patient-specific 3D printed models serve as a useful tool in preoperative planning and simulation of surgical procedures for treatment of renal tumours. Further studies with inclusion of more cases and with a focus on reducing the cost and 3D model production time deserve to be investigated.

The purpose of this study is to create three-dimensional (3D) printed models of renal tumours with use of homemade and commercially available 3D printers and compare the accuracy of 3D printed models in delineating renal tumours and costs associated with 3D printing between these 3D printers. Life-size 3D printed kidney models of two patients with suspected renal cell carcinoma were generated with use of high-resolution contrast-enhanced computed tomography (CT) images which were post-processed and segmented to show normal renal anatomy and renal tumours. Measurements of tumour diameters were performed at left to right and craniocaudal dimensions and were compared on 2D axial, multiplanar reformation (MPR) and 3D volume rendering CT images with those on 3D physical models to determine the accuracy differences between these techniques. 3D printed models were successfully generated by both commercial and home-made 3D printers with accurately replicating renal anatomy and renal tumours. Although there was no significant difference in measuring tumour diameters, measurements on 3D printed models between commercial and home-made 3D printers were within 0.9 mm in these two cases. Similarly, a good correlation was found in measurements made between 3D volume rendering images and 3D printed models with differences between 0.85 and 0.98 mm, 0.69 and 0.73 mm, for cases 1 and 2, respectively. Measurements in 3D printed models exceeded 2D axial and MPR measurements by an average of more than 1.5 mm. The printing cost per kidney model was US$1 and US$200 for home-made and commercial 3D printers, respectively. This study shows the feasibility of creating 3D printed models of demonstrating renal anatomy and renal tumours with use of home-made 3D printer with accuracy similar to that from commercial 3D printer, but at a much lower cost.