P593Oxygen sensitive cardiac magnetic resonance in demonstrating myocardial ischaemia of the right ventricle in patients with pulmonary artery hypertension

Background Progressive right ventricular (RV) dysfunction is a natural progression of pulmonary arterial hypertension (PAH) which is associated with adverse clinical outcomes. The main contributor to progressive RV dysfunction is RV ischemia. Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) has been used to determine the in-vivo myocardial oxygenation of the left ventricle (LV). Purpose The aim of the present study was to (1) Determine the feasibility of RV targeted rest/stress OS-CMR imaging in PAH patients and normal volunteers; (2) To define the presence and extent of RV myocardial ischaemia in patients with known PAH. Methods We prospectively recruited 20 patients with right heart catheter proven PAH and 9 normal (NC), age matched controls with no heart disease. The CMR examination involved standard functional imaging and OS-CMR imaging. OS-CMR images were acquired using a T2* sequence at rest and adenosine-induced stress vasodilatation. The RV was divided into 3 segments - RV anterior, RV free-wall and RV inferior. An OS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments. Results All the PAH patients tolerated and completed the adenosine induced stress OS-CMR without any complications or adverse effects. In NC, reliable OS signal intensity changes was only obtained from the RV inferior segment. As RV dysfunction in PAH is a global process, hence this segment was used in both patients and NC for further comparison. RV OS-CMR signal intensity change between rest and stress in the normal volunteers was 17±4% (mean ± SD). 9 out of twenty (45%) of the PAH patients had a mean BOLD signal intensity change of less than 9% (or 2SD different from the mean values in normal volunteers). Overall, RV OS SI index between the PAH patients and controls was 11±9% vs 17±5% (p-value = 0.045) in RV inferior segment. Conclusion Pharmacological induced OS-CMR is a feasible and safe technique to identify and study myocardial oxygenation in the RV of PAH patients.

Relationship between Signal Intensity Change of the Spinal Cord on MRI and Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy

Background: Diagnosis of cervical spondylotic myelopathy (CSM) can be challenging due to subtle symptoms and insidious onset; however, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy. Objective: The purpose of this present study was to find out the relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with CSM.Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients.Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T1WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24(66.6%) patients who had type 0 signal intensity on (T2WI) MRI. High Nurick score was found in 3(8.3%) patients who had type 0 signal intensity on (T2WI) MRI. Low Nurick score was found in 2(5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6(16.6%) patients who had type 1 signal intensity on (T2WI) MRI. Only 1 patient (2.7%) having high Nurick score (3-5) had type-2 signal intensity on (T2WI) MRI (p<0.001).Conclusion: There is a direct relationship between signal intensity change of the spinal cord on MRI and motor myelopathic severity in patients with cervical spondylotic myelopathy.Journal of National Institute of Neurosciences Bangladesh, 2015;1(2): 37-40

The Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Surgery Based on Iatrogenic Damage

Objectives: To examine the degenerative changes of adjacent cartilage and bony structure, after anterior cruciate ligament reconstruction surgery. Methods: 27 subjects, who had anterior cruciate ligament reconstruction surgery due to various reasons at least 12 months ago, were admitted to study. MRI data of patients were acquired retrospectively. Pre-operative and post-operative MRI images were compared according to retropatellar cartilage thickness, evidence of any new osteophytes formation or any signal intensity change on bony elements. Paired statistical analysis was applied. Results: The MRI revelation showed that; there were 14 patients with decrement of retropatellar cartilage thickness, 9 patients with new osteophytes formation and 21 patients with abnormal signal intensity change on bony elements; which were statistically significant (P<0.001). Conclusion: These results provide basic information about the degenerative effect of anterior cruciate ligament reconstruction surgery, on adjacent cartilage and bony structure.