BackgroundAdenosine or regadenoson vasodilator stress cardiovascular magnetic resonance (CMR) is an effective non-invasive strategy for evaluating symptomatic coronary artery disease. Vasodilator injection typically precedes ventricular functional sequences to efficiently reduce overall scanning times, though the effects of vasodilators on CMR-derived ventricular volumes and function are unknown.MethodsWe prospectively enrolled 25 healthy subjects to undergo consecutive adenosine and regadenoson administration. Short axis CINE datasets were obtained on a 1.5 T scanner following adenosine (140mcg/kg/min IV for 6 min) and regadenoson (0.4 mg IV over 10 s) at baseline, immediately following administration, at 5 min intervals up to 15 min. Hemodynamic response, bi-ventricular volumes and ejection fractions were determined at each time point.ResultsPeak heart rate was observed early following administration of both adenosine and regadenoson. Heart rate returned to baseline by 10 min post-adenosine while remaining elevated at 15 min post-regadenoson (p = 0.0015). Left ventricular (LV) ejection fraction (LVEF) increased immediately following both vasodilators (p < 0.0001 for both) and returned to baseline following adenosine by 10 min (p = 0.8397). Conversely, LVEF following regadenoson remained increased at 10 min (p = 0.003) and 15 min (p = 0.0015) with a mean LVEF increase at 15 min of 4.2 ± 1.3%. Regadenoson resulted in a similar magnitude reduction in both LV end-diastolic volume index (LVEDVi) and LV end-systolic volume index (LVESVi) at 15 min whereas LVESVi resolved at 15 min following adenosine and LVEDVi remained below baseline values (p = 0.52).ConclusionsRegadenoson and adenosine have significant and prolonged impact on ventricular volumes and LVEF. In patients undergoing vasodilator stress CMR where ventricular volumes and LVEF are critical components to patient care, ventricular functional sequences should be performed prior to vasodilator use or consider the use of aminophylline in the setting of regadenoson. Additionally, heart rate resolution itself is not an effective surrogate for return of ventricular volumes and LVEF to baseline.
Radiography is the fi rst-line imaging modality for the evaluation of traumatic wrist injury, which is encountered commonly in the daily practice of a diagnostic radiologist. Because of the complex anatomy and overlapping structures of the wrist on standard radiographic projections, abnormalities of the wrist can be subtle and easily overlooked. Therefore, it is essential for radiologists to be profi cient at the interpretation of wrist radiographs. The use of a checklist approach, and recognition of common injury patterns, potentially can increase radiologists' accuracy when interpreting standard wrist radiographs. The objective of this article is to present a simple but thorough method for accurate radiographic evaluation of the wrist and to review some common injury patterns of the wrist. Radiographic Evaluation of the WristCommon views of the wrist include posteroanterior (PA), lateral, and oblique projections. With the PA view, the wrist V o l u m e 3 8 • N u m b e r 2 0 S e p t e m b e r 3 0 , 2 0 1 5 This issue of CDR will qualify for 2 ABR Self-Assessment Module SAM (SA-CME) credits. See page 8 for more information. This module meets the American Board of Radiology's (ABR's) criteria for self-assessment toward the purpose of fulfi lling requirements in the ABR Maintenance of Certifi cation (MOC) program.Please note that in addition to the SA-CME credits, subscribers completing the activity will receive the usual ACCME credits. After participating in this activity, the diagnostic radiologist should be better able to identify the anatomic landmarks of the wrist on radiography and become familiar with a systematic checklist approach to the radiographic interpretation of the injured wrist.
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