Non-contrast-enhanced whole-heart coronary MRA at 1.5-T can noninvasively detect significant CAD with high sensitivity and moderate specificity. A negative predictive value of 88% indicates that whole-heart coronary MRA can rule out CAD.
BackgroundIn pancreaticoduodenectomy (PD) with resection of portal vein (PV)/superior mesenteric vein (SMV) confluence, the splenic vein (SV) division may cause left-sided portal hypertension (LPH).MethodsThe 88 pancreatic ductal adenocarcinoma patients who underwent PD with PV/SMV resection after chemoradiotherapy were classified into three groups: both SV and splenic artery (SA) were preserved in Group A (n = 16), SV was divided and SA was preserved in Group B (n = 58), and both SV and SA were divided in Group C (n = 14). We evaluated the influence of resection of SV and/or SA on LPH after PD with resection of PV/SMV confluence.ResultsThe incidence of postoperative varices in Groups A, B and C was 6.3, 67.2 and 38.5%, respectively (p < 0.001), and variceal bleeding occurred only in Group B (n = 4: 6.8%). In multivariate analysis, Group B was the only significant risk factor for the development of postoperative varices (Groups B vs. A: odds ratio = 39.6, p = 0.001, Groups C vs. A: odds ratio = 8.75, p = 0.066). The platelet count ratio at 6 months after operation comparing to preoperative value was 0.93, 0.73 and 1.09 in Groups A, B and C, respectively (Groups B vs. C: p < 0.05), and spleen volume ratio at 6 months was 1.00, 1.37 and 0.96 in Groups A, B and C, respectively (Groups B vs. A and C: p < 0.01 and p < 0.05).ConclusionIn PD with resection of PV–SMV confluence, the SV division causes LPH, but the concomitant division of SV and SA may attenuate it.
For the absolute quantification of myocardial blood flow (MBF), Patlak plot-derived K1 need to be converted to MBF by using the relation between the extraction fraction of gadolinium contrast agent and MBF. This study was conducted to determine the relation between extraction fraction of Gd-DTPA and MBF in human heart at rest and during stress. Thirty-four patients (19 men, mean age of 66.5 6 11.0 years) with normal coronary arteries and no myocardial infarction were retrospectively evaluated. First-pass myocardial perfusion MRI during adenosine triphosphate stress and at rest was performed using a dual bolus approach to correct for saturation of the blood signal. Myocardial K1 was quantified by Patlak plot method. Mean MBF was determined from coronary sinus flow measured by phase contrast cine MRI and left ventricle mass measured by cine MRI. The extraction fraction of Gd-DTPA was calculated as the K1 divided by the mean MBF. The extraction fraction of Gd-DTPA was 0.46 6 0.22 at rest and 0.32 6 0.13 during stress (P < 0.001). The relationship between extraction fraction (E) and MBF in human myocardium can be approximated as E 5 1 2 exp(2(0.14 3 MBF 1 0.56)/MBF). The current results indicate that MBF can be accurately quantified by Patlak plot method of first-pass myocardial perfusion MRI by performing a correction of extraction fraction. Magn Reson Med 66:1391-1399,
ancreatic cancer is the fourth leading cause of cancerrelated mortality in the United States. In 2018, an estimated 55 440 people were diagnosed with pancreatic cancer, and 44 330 people died of it (1). Neoadjuvant chemotherapy and radiation therapy (CRT) is increasingly used to treat potentially resectable pancreatic ductal adenocarcinoma (PDA), especially for borderline resectable disease, as an alternative to surgery. CRT improves the rates of negativemargin resections and possibly treats early micrometastatic disease. However, neoadjuvant CRT is not entirely safe and is sometimes associated with toxicity and disease progression. Consequently, it is important to identify patients likely to respond to CRT to avoid unnecessary drug toxicity while maximizing the chances of tumor regression.In PDA, conventional multiphasic CT is the most widely used imaging modality to evaluate response to therapy by using the Response Evaluation Criteria in Solid Tumors (RECIST). However, it is becoming evident that conventional CT imaging-through assessment of serial tumor size changes-is insufficient for reliable response evaluation after neoadjuvant CRT because of poor correlation with histologic grading of response (2-4). This poor performance can be explained by the abundant fibrous stroma of PDA, which cannot be differentiated from posttherapy fibrous scarring.Obtaining negative pathologic margins (R0) after surgery is an important marker of therapy in PDA. Patients with PDA with R0 have significantly longer survival than patients with positive margins (5,6). Recently, the rate of R0 resection is increasing with the use of neoadjuvant CRT. In a study by Chatterjee et al ( 7), R0 resection was achieved in approximately 90% of patients with PDA
QA of coronary MR angiograms with use of a signal intensity profile along the vessel permits detection of CAD. This method had a diagnostic performance approximately equal to that of visual analysis of coronary MR angiograms with high inter- and intraobserver reliability, allowing for more objective interpretation of coronary MR angiography findings.
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