No abstract

To explore the feasibility of CT-derived myocardial strain measurement in patients with advanced cardiac valve disease and to compare it to strain measurements derived from transthoracic echocardiography (TTE). 43 consecutive patients with advanced cardiac valve disease and clinically indicated retrospectively gated cardiac CTs were retrospectively analyzed. The longitudinal, circumferential as well as radial systolic strain were determined in all patients utilizing a commercially available CT strain software. In 36/43 (84%) patients, CT-derived longitudinal strain was compared to speckle-tracking TTE. Pearson’s correlation coefficients as well as Bland–Altman analysis were used to compare the CT-derived strain measurements to TTE. The intra- and inter-reader-reliability of the CT-derived strain measurements were assessed by intra-class correlation coefficients (ICCs). Strain measurements were feasible in all patients. CT-derived global longitudinal strain (GLS) correlated moderately with TTE-derived GLS (r = 0.6, p < 0.001). A moderate correlation between CT-derived GLS and CT-derived left ventricular ejection fraction was found (LVEF, r = − 0.66, p = 0.036). Bland–Altman analysis showed a systematic underestimation of myocardial strain by cardiac CT compared to TTE (mean difference: − 5.8%, 95% limit of agreement between − 13.3 and 1.8%). Strain measurements showed an excellent intra- and inter-reader-reliability with an intra-reader ICC of 1.0 and an inter-reader ICC of 0.99 for GLS measurements. CT-derived myocardial strain measurements are feasible in patients with advanced cardiac valve disease. They are highly reproducible and correlate with established parameters of strain measurements. Our results encourage the implementation of CT-derived strain measurement into clinical routine.

Background Idiopathic recurrent cervical swelling may be caused by lymphatic abnormalities. Methods Ten patients (9 females, mean age 51.2 ± 7) with idiopathic recurrent cervical swelling underwent MR‐lymphangiography (MRL). MR‐lymphangiograms were evaluated regarding lymphatic anatomy and flow. Individualized treatment was recommended according to MRL‐findings. Results 8/10 patients presented with left‐sided, 2/10 with right‐sided swelling. Pathological lymph‐flow was identified in all cases: thoracic duct dilatation in patients with left‐sided and right lymphatic duct dilatation in right‐sided swelling, accessory thoracic lymphatics in 7/10 and reflux in 8/10 cases. In two cases, a lymphatic thrombus was identified. After treatment, symptoms resolved completely in 6/10 cases and partially in 1/10 cases. The remaining three patients have intermittent swellings but have no treatment wish. Conclusion Idiopathic recurrent cervical swelling can be caused by lymphatic anomalies. MRL displays impaired lymphatic drainage, lymphatic vessel dilatation, and chylolymphatic reflux as hallmarks of this condition and may aid in targeted treatment planning.

Purpose This overview summarizes key points of complication management in vascular and non-vascular interventions, particularly focusing on complication prevention and practiced safety culture. Flowcharts for intervention planning and implementation are outlined, and recording systems and conferences are explained in the context of failure analysis. In addition, troubleshooting by interventionalists on patient cases is presented. Material and Methods The patient cases presented are derived from our institute. Literature was researched on PubMed. Results Checklists, structured intervention planning, standard operating procedures, and opportunities for error and complication discussion are important elements of complication management and essential for a practiced safety culture. Conclusion A systematic troubleshooting and a practiced safety culture contribute significantly to patient safety. Primarily, a rational and thorough error analysis is important for quality improvement. Key Points: Citation Format

Background Epicardial (ECF) and pericardial fat (PCF) are important prognostic markers for various cardiac diseases. However, volumetry of the fat compartments is time-consuming. Purpose To investigate whether total volume of ECF and PCF can be estimated by axial single-slice measurements and in a four-chamber view. Material and Methods A total of 113 individuals (79 patients and 34 healthy) were included in this retrospective magnetic resonance imaging (MRI) study. The total volume of ECF and PCF was determined using a 3D-Dixon sequence. Additionally, the area of ECF and PCF was obtained in single axial layers at five anatomical landmarks (left coronary artery, right coronary artery, right pulmonary artery, mitral valve, coronary sinus) of the Dixon sequence and in a four-chamber view of a standard cine sequence. Pearson's correlation coefficient was calculated between the total volume and each single-slice measurement. Results Axial single-slice measurements of ECF and PCF correlated strongly with the total fat volumes at all landmarks (ECF: r  =  0.85–0.94, P < 0.001; PCF: r  =  0.89–0.94, P < 0.001). The best correlation was found at the level of the left coronary artery for ECF and PCF ( r  =  0.94, P < 0.001). Correlation between single-slice measurement in the four-chamber view and the total ECF and PCF volume was lower ( r  =  0.75 and r  =  0.8, respectively, P < 0.001). Conclusion Single-slice measurements allow an estimation of ECF and PCF volume. This time-efficient analysis allows studies of larger patient cohorts and the opportunistic determination of ECF/PCF from routine examinations.