scholarly journals Cardiac MRI and Myocardial Injury in COVID-19: Diagnosis, Risk Stratification and Prognosis

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Saagar K. Sanghvi ◽  
Logan S. Schwarzman ◽  
Noreen T. Nazir
Keyword(s):  
Risk Stratification ◽  
Myocardial Injury ◽  
Cardiac Tissue ◽  
Contractile Function ◽  
Imaging Modality ◽  
Acute Myocarditis ◽  
Myocardial Inflammation ◽  
Critical Data ◽  
Non Invasive ◽  
Risk Of Exposure

Myocardial injury is a common complication of the COVID-19 illness and is associated with a worsened prognosis. Systemic hyperinflammation seen in the advanced stage of COVID-19 likely contributes to myocardial injury. Cardiac magnetic resonance imaging (CMR) is the preferred imaging modality for non-invasive evaluation in acute myocarditis, enabling risk stratification and prognostication. Modified scanning protocols in the pandemic setting reduce risk of exposure while providing critical data regarding cardiac tissue inflammation and fibrosis, chamber remodeling, and contractile function. The growing use of CMR in clinical practice to assess myocardial injury will improve understanding of the acute and chronic sequelae of myocardial inflammation from various pathological etiologies.

scholarly journals Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis

Heart ◽  
2017 ◽  
Vol 104 (4) ◽  
pp. 300-305 ◽  
Author(s):  
Colin G Stirrat ◽  
Shirjel R Alam ◽  
Thomas J MacGillivray ◽  
Calum D Gray ◽  
Marc R Dweck ◽  
...  
Keyword(s):  
Acute Myocarditis ◽  
T2 Mapping ◽  
Relevant Information ◽  
Substantial Contribution ◽  
Myocardial Inflammation ◽  
Myocardial Oedema ◽  
Clinical Trial Registration ◽  
Macrophage Activity ◽  
Non Invasive ◽  
Enhanced Mri

ObjectivesUltrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect tissue-resident macrophage activity and identify cellular inflammation within tissues. We hypothesised that USPIO-enhanced MRI would provide a non-invasive imaging technique that would improve the diagnosis and management of patients with acute myocarditis.MethodsTen volunteers and 14 patients with suspected acute myocarditis underwent T2, T2* and late gadolinium enhancement (LGE) 3T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months. Myocardial oedema and USPIO enhancement were determined within areas of LGE as well as throughout the myocardium.ResultsMyocarditis was confirmed in nine of the 14 suspected cases of myocarditis. There was greater myocardial oedema in regions of LGE in patients with myocarditis when compared with healthy volunteer myocardium (T2 value, 57.1±5.3 vs 46.7±1.6 ms, p<0.0001). There was no demonstrable difference in USPIO enhancement between patients and volunteers even within regions displaying LGE (change in R2*, 35.0±15.0 vs 37.2±9.6 s−1, p>0.05). Imaging after 3 months in patients with myocarditis revealed a reduction in volume of LGE, a reduction in oedema measures within regions displaying LGE and improvement in ejection fraction (mean −19.7 mL, 95% CI (−0.5 to −40.0)), −5.8 ms (−0.9 to −10.7) and +6% (0.5% to 11.5%), respectively, p<0.05 for all).ConclusionIn patients with acute myocarditis, USPIO-enhanced MRI does not provide additional clinically relevant information to LGE and T2 mapping MRI. This suggests that tissue-resident macrophages do not provide a substantial contribution to the myocardial inflammation in this condition.Clinical trial registration NCT02319278; Results.

scholarly journals The unique role of cardiovascular magnetic resonance imaging in acute myocarditis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1153 ◽  
Author(s):  
Michael Chetrit ◽  
Matthias G. Friedrich
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Acute Myocarditis ◽  
T2 Mapping ◽  
Regional Distribution ◽  
Viral Myocarditis ◽  
Added Value ◽  
Current Evidence ◽  
Myocardial Inflammation ◽  
Non Invasive

This article addresses the specific diagnostic information provided by cardiovascular magnetic resonance (CMR) in patients with suspected acute myocarditis. It gives an overview of the current evidence of the ability of CMR to detect myocardial inflammation and discusses the added value as well as its limitations in clinical settings. Because of the large variety of symptoms and the limited specificity of other non-invasive procedures, the identification of myocardial inflammation is of paramount importance. Because of its accuracy in imaging ventricular volumes and function and its unique ability to visualize myocardial edema, scar, and other tissue abnormalities, CMR has emerged as the prime non-invasive diagnostic tool in patients with acute myocarditis. The presence of myocardial inflammation is not specific to viral myocarditis or other forms of acute myocardial injury, and the regional distribution within the myocardium helps differentiate acute myocarditis from other diseases. The currently recommended diagnostic criteria (Lake Louise Criteria) include markers for hyperemia/capillary leak, edema, and inflammatory scarring. Their diagnostic accuracy of close to 80% is satisfactory to rule in myocarditis, yet the negative predictive value is less than 70%. Novel CMR techniques, especially T1 and T2 mapping, have been shown to further improve the diagnostic utility.

scholarly journals Clinical presentation of myocarditis in pediatric: the role of cardiac magnetic resonance in diagnosis

2014 ◽  
Vol 23 (3) ◽  
pp. 174-81
Author(s):  
Sisca Natalia ◽  
Octavia Lilyasari ◽  
Sony H. Wicaksono ◽  
Manoefris Kasim
Keyword(s):  
Myocardial Injury ◽  
Clinical Presentation ◽  
Acute Myocarditis ◽  
Myocardial Edema ◽  
High Accuracy ◽  
Normal Function ◽  
Left Ventricular ◽  
Non Invasive ◽  
Acute Condition

Myocarditis is an inflammatory disease of myocard with varied onset and clinical presentation which lead to diagnosis difficulties. These difficulties often cause incoming patients with acute condition are not diagnosed as acute myocarditis that subsequently may lead to improper therapy. This circumstance will probably cause more severe myocardial injury and even sudden death. On another circumstance, patients may also come late in conditions of dilated cardiomyopathy (DCM) or aritmogenik cardiomyopathy (ARVD) due to complexities of myocarditis early detection. Therefore, myocarditis diagnosis is extremely important. This case shows how CMR is important and highly accurate in diagnosing myocarditis through a case whereby a boy had complaints of chest pain and his CMR examination showed normal cardiac morphology with normal function of right and left ventricular, but with myocardial edema and tissue fibrosis, which confirmed the diagnosis of myocarditis according to the Lake Louise Consensus criteria. CMR is an important and high accuracy non-invasive diagnostic tool in myocarditis diagnosis.

A novel use of contrast-enhanced ultrasound in uterine artery embolization

2020 ◽  
Vol 4 ◽  
pp. 8
Author(s):  
Jemianne Bautista Jia ◽  
Eric Mastrolonardo ◽  
Mateen Soleman ◽  
Ilya Lekht
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Imaging Modality ◽  
Cost Effective ◽  
Contrast Enhanced Ultrasound ◽  
Artery Embolization ◽  
Non Invasive ◽  
Contrast Enhanced

Contrast-enhanced ultrasound (CEUS) is a cost-effective, quick, and non-invasive imaging modality that has yet to be incorporated in uterine artery embolization (UAE). We present two cases that demonstrate the utility of CEUS in UAE for the identification of uterine-ovarian collaterals which otherwise can result in ineffective fibroid treatment and non-target embolization.

The Use of Sonography in Pediatrics: The Bioethical Concerns in Clinical and Research Practice

2021 ◽  
pp. 875647932110350
Author(s):  
Nicole Weikle
Keyword(s):  
Clinical Setting ◽  
Imaging Modality ◽  
Pediatric Population ◽  
Well Being ◽  
Ethical Principles ◽  
Pediatric Care ◽  
Research Practice ◽  
Ethical Guidelines ◽  
Non Invasive ◽  
Clinical Pediatric

Sonography has been widely used in both a clinical and non-clinical setting. This imaging modality is a common tool of choice for both physicians and researchers. Although sonography is a non-ionizing and non-invasive tool for imaging, special considerations need to be made when working with the pediatric population. Ethical guidelines for clinical pediatric care and research need to consider the varying ethical guidelines and bioethical concerns in children. As sonographers, researchers, educators and clinicians, pediatric care and research must balance the protection of children and the need for imaging to improve pediatric well-being. The discussion of this paper will delve into The Principles Approach developed by Beauchamp and Childress. Each principle will be explored and how those ethical principles could be considered in pediatric care.

scholarly journals Risk assessment in precapillary pulmonary hypertension: a comparative analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Sonnweber ◽  
Eva-Maria Schneider ◽  
Manfred Nairz ◽  
Igor Theurl ◽  
Günter Weiss ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Assessment Tool ◽  
Risk Models ◽  
Non Invasive

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

scholarly journals Role of MRI in the diagnosis of adult traumatic and obstetric brachial plexus injury compared to intraoperative findings

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Doria Mohammed Gad ◽  
Mostafa Thabet Hussein ◽  
Nagham Nabil Mahmoud Omar ◽  
Mohamed Mostafa Kotb ◽  
Mohamed Abdel-Tawab ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Tissue Characterization ◽  
Brachial Plexus Injury ◽  
Imaging Modality ◽  
Preoperative Evaluation ◽  
Diagnostic Modality ◽  
Non Invasive ◽  
Upper Limb Function ◽  
Obstetric Brachial Plexus ◽  
Sensitivity Specificity

Abstract Background Brachial plexus injury occurs following birth trauma or adult trauma as well, surgical repair is important to regain upper limb function, and preoperative evaluation with MRI is important and considered the accurate and safe imaging modality. Thirty-seven patients with clinically suspected obstetric (15 patients) or adult traumatic (22 patients) brachial plexus injury were included in our study; all of them underwent MRI examination including T1WI, T2WI, STIR, DWIBS, 3D STIR SPACE, and MR myelography sequences. Results In obstetric cases, MRI sensitivity, specificity, and accuracy for preganglionic injury were 63%, 89%, and 82%, respectively, while for postganglionic lesions, MRI sensitivity, specificity, and accuracy were 60%, 99%, and 95%, respectively. In adult cases, MRI sensitivity, specificity, and accuracy for preganglionic injury were 96%, 95%, and 95% respectively, while for postganglionic injury, MRI sensitivity, specificity, and accuracy were 60%, 100%, and 99%, respectively. Conclusion MRI represents a safe, non-invasive, diagnostic modality having the multiplanar capability and better soft tissue characterization.

Biological variation of cardiac myosin-binding protein C in healthy individuals

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Bashir Alaour ◽  
Torbjørn Omland ◽  
Janniche Torsvik ◽  
Thomas E. Kaier ◽  
Marit S. Sylte ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Protein C ◽  
Myocardial Injury ◽  
Binding Protein ◽  
Biological Variation ◽  
Cardiac Myosin ◽  
Analytical Quality ◽  
Myosin Binding Protein ◽  
Myosin Binding Protein C ◽  
Myosin Binding

Abstract Objectives Cardiac myosin-binding protein C (cMyC) is a novel biomarker of myocardial injury, with a promising role in the triage and risk stratification of patients presenting with acute cardiac disease. In this study, we assess the weekly biological variation of cMyC, to examine its potential in monitoring chronic myocardial injury, and to suggest analytical quality specification for routine use of the test in clinical practice. Methods Thirty healthy volunteers were included. Non-fasting samples were obtained once a week for ten consecutive weeks. Samples were tested in duplicate on the Erenna® platform by EMD Millipore Corporation. Outlying measurements and subjects were identified and excluded systematically, and homogeneity of analytical and within-subject variances was achieved before calculating the biological variability (CVI and CVG), reference change values (RCV) and index of individuality (II). Results Mean age was 38 (range, 21–64) years, and 16 participants were women (53%). The biological variation, RCV and II with 95% confidence interval (CI) were: CVA (%) 19.5 (17.8–21.6), CVI (%) 17.8 (14.8–21.0), CVG (%) 66.9 (50.4–109.9), RCV (%) 106.7 (96.6–120.1)/−51.6 (−54.6 to −49.1) and II 0.42 (0.29–0.56). There was a trend for women to have lower CVG. The calculated RCVs were comparable between genders. Conclusions cMyC exhibits acceptable RCV and low II suggesting that it could be suitable for disease monitoring, risk stratification and prognostication if measured serially. Analytical quality specifications based on biological variation are similar to those for cardiac troponin and should be achievable at clinically relevant concentrations.

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