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AimTo evaluate a combined protocol for simultaneous cardiac MRI (CMR) and contrast-enhanced (CE) whole-body MR angiography (WB-MRA) techniques within a single examination.Materials and methodsAsymptomatic volunteers (n = 48) with low-moderate risk of cardiovascular disease (CVD) were recruited. The protocol was divided into four sections: (1) CMR of left ventricle (LV) structure and function; (2) CE-MRA of the head, neck, and thorax followed by the distal lower limbs; (3) CMR LV “late gadolinium enhancement” assessment; and (4) CE-MRA of the abdomen and pelvis followed by the proximal lower limbs. Multiple observers undertook the image analysis.ResultsFor CMR, the mean ejection fraction (EF) was 67.3 ± 4.8% and mean left ventricular mass (LVM) was 100.3 ± 22.8 g. The intra-observer repeatability for EF ranged from 2.1–4.7% and from 9–12 g for LVM. Interobserver repeatability was 8.1% for EF and 19.1 g for LVM. No LV delayed myocardial enhancement was observed. For WB-MRA, some degree of luminal narrowing or stenosis was seen at 3.6% of the vessel segments (involving n = 29 of 48 volunteers) and interobserver radiological opinion was consistent in 96.7% of 1488 vessel segments assessed.ConclusionCombined assessment of WB-MRA and CMR can be undertaken within a single examination on a clinical MRI system. The associated analysis techniques are repeatable and may be suitable for larger-scale cardiovascular MRI studies.

INTRODUCTION While there are a lot of data on the accuracy of computed tomography (CT) in diagnosing specific causes of an acute abdomen, there is very little information on the accuracy of CT in the acute general surgical admissions workload. We look at the diagnostic accuracy of CT in patients presenting with an acute abdomen who ultimately required a laparotomy. METHODS Patients who underwent an emergency laparotomy between 2008 and 2010 at Eastbourne District General Hospital with pre-operative CT on the same admission were included in the study. The CT report was compared with the laparotomy and histology findings and, where a discrepancy existed, the original imaging was reviewed by a senior consultant blinded to the original report and laparotomy findings. RESULTS A total of 196 emergency laparotomies were performed over the 2-year period, with 112 patients undergoing preoperative CT. Fifteen patients were excluded from the study due to missing notes. In the remaining 97 patients, 80 CT reports correlated with the final operative diagnosis, giving a diagnostic accuracy of 82%. Of these, the on-call registrar was the initial reporter in 37 scans, with a diagnostic accuracy of 78%. On review of the CT by a second consultant, this increased to 90 correlations, yielding an accuracy of 93%. Delay between CT and the operation did not significantly alter diagnostic accuracy, nor was there any statistically significant reduction in accuracy in reports issued by on-call registrars. CONCLUSIONS On first reporting, CT misses 18% of diagnoses that ultimately require operative intervention. Reducing the threshold for obtaining a second consultant radiologist review significantly improves the diagnostic accuracy to 93%.

BackgroundEctopic fat stored in the epicardium has previously been associated with coronary heart disease. However the role of type-2 diabetes mellitus (T2DM) in epicardial fat deposition has not been well explored. This study compares the volume of epicardial and paracardial fat in a T2DM cohort with and without cardiovascular disease (CVD) and matched non-diabetic cohorts.MethodsA cohort of 158 participants were categorised into one of 4 groups: 1-T2DM with CVD; 2-T2DM without CVD; 3-CVD without T2DM; 4-Healthy controls. Measurements were performed on 4 chamber cardiac magnetic resonance (CMR) images using Segment (v2.0-R4339 (). Epicardial adipose tissue (EAT) was defined as fat within the visceral pericardium while paracardial adipose tissue (PAT) was defined as fat out with the parietal pericardium.ResultsIn total, 148 participants completed the MRI study protocol (61% male, 64 ± 8.2 years). EAT was highest in those with CVD without diabetes (15.2 ± 6.6 cm2), followed by those with T2DM and CVD (14.3 ± 6.4 cm2), then those with T2DM only (13.1 ± 4.6 cm2) with healthy controls having the lowest EAT (10.8 ± 5.0 cm2) (F = 3.5, p = 0.016). No difference between the groups was observed for PAT (F = 2.1, p = 0.1). Post-hoc analysis showed only the non-diabetic CVD group to have significantly higher EAT than the healthy controls with no other significant differences between the groups. These differences persisted when accounting for differences in BMI between the groups (ANCOVA F = 2.9, p = 0.038).ConclusionEAT was higher in non-diabetics with CVD, but not in T2DM with or without CVD. This suggests EAT may play a greater role in CVD in non-diabetics than those with T2DM.