No abstract

Background-We used diffusion-tensor cardiac MR to investigate myocardial microstructure changes, including tissue integrity (mean diffusivity [MD], fractional anisotropy) and fiber architecture (helix angles) in patients with recent myocardial infarction (MI). This study aimed to investigate the sequential changes of myocardial microstructure and its relationships with changes of macrostructure and function of the left ventricle post-MI. Methods and Results-Seventeen patients (age, 55.1Ϯ11.5 years; all men) participated in the follow-up study.Diffusion-tensor cardiac MR, cine gradient echo for left ventricle function, and late gadolinium enhancement for viability were measured from recent to chronic MI (median interval, 191 days). When compared with the remote zone, the infarct-adjacent zone showed overall increase of MD (2-way MANOVA, F 1,16 ϭ36.3; PϽ0.001), decrease of fractional anisotropy (F 1,16 ϭ5.8; Pϭ0.029), and decrease of mean helix angles (F 1,16 ϭ62.0; PϽ0.001). From recent to chronic MI, there was overall sequential decrease of MD (F 1,16 ϭ22.6; PϽ0.001) and increase of fractional anisotropy (F 1,16 ϭ7.8; Pϭ0.013). Multiple linear regression showed that the improvement of wall thickening in the infarct-adjacent zone correlated with sequential decrease of MD in the infarct-adjacent zone (rϭϪ0.70; Pϭ0.002) and increase of mean helix angles (ie, more right-handed helical myofiber reorientation, predominantly subendocardial location) in the remote zone (rϭ0.60; Pϭ0.011). Likewise, wall thickening in the remote zone correlated with MD in the remote zone (rϭϪ0.72; Pϭ0.001) and mean helix angles in the infarct-adjacent zone (rϭ0.72; Pϭ0.001). Key Words: imaging Ⅲ magnetic resonance imaging Ⅲ myocardial infarction Ⅲ remodeling P ostinfarction late remodeling involves the left ventricle (LV) globally and is associated with time-dependent dilatation, distortion of ventricular shape, rearrangement of fiber architecture, and mural hypertrophy. 1 Clearly, there is a great need for, and utility in, the in vivo acquisition of a wealth of cardiac microstructures such as geometry, fiber and sheet orientation, and cell populations to improve our ability to design strategies for effective restoration of myocardium postinfarction. 2,3 Conclusion-Diffusion-tensor Editorial see p 4 Clinical Perspective see p 40Recently, diffusion-tensor cardiac MR (DT-CMR) has emerged as a unique method for the nondestructive reconstruction of the fiber structure of the LV, which has been validated to have strong correspondence with fiber orientation by histological correlation 4 -6 and also has been modified to advance its Received March 11, 2008; accepted November 6, 2008. application to the living human heart. 7-10 In a previous report, we used DT-CMR to observe the alteration of tissue integrity, indicated by mean diffusivity (MD, also known as traceapparent diffusion coefficient), fractional anisotropy (FA), and fiber architecture, indicated by helix angles (HA), in patients post-myocardial infarction (MI) at a median interval...

The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.

Given its simplicity, we proposed that quantitative CT be widely used in predicting postoperative FEV1.

Background. This randomized controlled study was objectively designed to evaluate the utility cisplatin (50 mg) in transcatheter arterial embolization (TAE) for treatment of hepatocellular carcinoma (HCC). Methods. From May 1991 to July 1993, 46 patients were included in the study. All had a pathologic verification of HCC. Clinically, all of the patients were considered inoperable. However, these patients satisfied eligibility criteria for TAE. The patients were divided into two groups by random sampling. In group I, 22 patients received TAE with the regimen of cisplatin (50 mg) mixed with Lipiodol 5‐15 ml followed by gelfoam pieces. In group II, 24 patients, as a controlled group, used the regimen of Lipiodol and gelfoam (Spongostan Film, Ferrosan, Denmark) pieces only, without adding any anticancer drug. The two groups were evaluated by a series of imaging studies and various clinical examinations before and after TAE. Subsequently, TAE was performed every 2 or 3 months for all patients until there was no visible tumor, or the patient could not sustain further TAE, or the patient died. Results. In group I, TAE was administered 61 times (average 2 8 times for each patient), and in group II, 73 times (average 3 times for each patient). The 1‐year and 2‐year survival rates of group I were 52.5% and 26.2%, and group II were 72.5% and 39.5%. Statistically, there was no significant difference in survival curves and survival rates between these two groups. Tumor response rate of group I was 68% (15/22) and group II was 67% (16/24). There was no significant difference in tumor response be tween these two groups. The liver and renal function studies after TAE also showed no significant difference between these two groups. Conclusions. Based on this controlled study, the authors conclude that the addition of cisplatin does not enhance the therapeutic effect of TAE for treatment of HCC.

BackgroundLethal pancreatitis has been reported after treatment for common bile duct stones using small endoscopic papillary balloon dilation.MethodsWe retrospectively evaluated the safety and efficacy of using large balloon dilation alone without the use of sphincterotomy for the treatment of large common bile duct stones in Kaohsiung Veterans General Hospital. Success rate of stone clearance, procedure-related adverse events and incidents, frequency of mechanical lithotripsy use, and recurrent stones were recorded.ResultsA total of 247 patients were reviewed in the current study. The mean age of the patients was 71.2 years. Most of them had comorbidities. Mean stone size was 16.4 mm. Among the patients, 132 (53.4%) had an intact gallbladder and 121 (49%) had a juxtapapillary diverticulum. The mean size of dilating balloon used was 13.2 mm. The mean duration of the dilating procedure was 4.7 min. There were 39 (15.8%) patients required the help of mechanical lithotripsy while retrieving the stones. The final success rate of complete retrieval of stones was 92.7%. The rate of pancreatic duct enhancement was 26.7% (66/247). There were 3 (1.2%) adverse events and 6 (2.4%) intra-procedure bleeding incidents. All patients recovered completely after conservative and endoscopic treatment respectively, and no procedure-related mortality was noted. 172 patients had a follow-up duration of more than 6 months and among these, 25 patients had recurrent common bile duct stones. It was significantly correlated to the common bile duct size (p = 0.036)ConclusionsEndoscopic papillary large balloon dilation alone is simple, safe, and effective in dealing with large common bile duct stones in relatively aged and debilitated patients.

Long retention of the alcohol in a single-injection technique is safe and effective. Two-hour alcohol retention has a comparable efficacy to that of 4-hour retention.

Female urethral diverticulum is an uncommon pathologic entity and can manifest with a variety of symptoms involving the lower urinary tract. Selection of the appropriate imaging modality is critical in establishing the diagnosis. Urethrography has traditionally been used in the evaluation of urethral diverticulum but provides only intraluminal information. Ultrasonography is advantageous in that it does not involve ionizing radiation and has the capacity to help detect a diverticulum without contrast agent filling. Multidetector computed tomographic (CT) voiding urethrography yields urethral images during micturition. In addition, the diverticulum and diverticular orifice can be visualized on two- and three-dimensional reformatted CT images. Interactive virtual urethroscopy provides simulated visualization of the intraluminal anatomy and the diverticular orifice. New magnetic resonance imaging techniques that make use of a surface or endoluminal coil have higher diagnostic accuracy and can delineate the diverticular cavity and help detect related complications. Clinicians should consider the possibility of a urethral diverticulum in women with chronic or recurrent lower urinary tract symptoms. Moreover, because female urethral diverticulum is becoming more prevalent in clinical practice, radiologists should be familiar with its imaging features and with the imaging techniques that are optimal for its evaluation.