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Clinical Cardiology Jul 2024We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG.
METHODS
A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
RESULTS
A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.
CONCLUSION
The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
Topics: Humans; Coronary Artery Bypass; Myocardial Ischemia; Ventricular Function, Left; Tissue Survival; Myocardium; Cardiomyopathies; Ventricular Dysfunction, Left; Coronary Artery Disease; Magnetic Resonance Imaging, Cine; Echocardiography, Stress; Tomography, Emission-Computed, Single-Photon
PubMed: 38953367
DOI: 10.1002/clc.24307 -
Diagnostic and Interventional Radiology... Jul 2024Although artificial intelligence (AI) methods hold promise for medical imaging-based prediction tasks, their integration into medical practice may present a double-edged...
Although artificial intelligence (AI) methods hold promise for medical imaging-based prediction tasks, their integration into medical practice may present a double-edged sword due to bias (i.e., systematic errors). AI algorithms have the potential to mitigate cognitive biases in human interpretation, but extensive research has highlighted the tendency of AI systems to internalize biases within their model. This fact, whether intentional or not, may ultimately lead to unintentional consequences in the clinical setting, potentially compromising patient outcomes. This concern is particularly important in medical imaging, where AI has been more progressively and widely embraced than any other medical field. A comprehensive understanding of bias at each stage of the AI pipeline is therefore essential to contribute to developing AI solutions that are not only less biased but also widely applicable. This international collaborative review effort aims to increase awareness within the medical imaging community about the importance of proactively identifying and addressing AI bias to prevent its negative consequences from being realized later. The authors began with the fundamentals of bias by explaining its different definitions and delineating various potential sources. Strategies for detecting and identifying bias were then outlined, followed by a review of techniques for its avoidance and mitigation. Moreover, ethical dimensions, challenges encountered, and prospects were discussed.
PubMed: 38953330
DOI: 10.4274/dir.2024.242854 -
Clinical Cardiology Jul 2024Papillary muscle (PM) infarction (PMI) detected by cardiac magnetic resonance imaging (CMR) is associated with poor outcomes. Whether PM parameters provide more value...
BACKGROUND
Papillary muscle (PM) infarction (PMI) detected by cardiac magnetic resonance imaging (CMR) is associated with poor outcomes. Whether PM parameters provide more value for mitral regurgitation (MR) management currently remains unclear. Therefore, we examined the prognostic value of PMI using CMR in patients with MR.
METHODS
Between March 2018 and July 2023, we retrospectively enrolled 397 patients with MR undergoing CMR. CMR was used to detect PMI qualitatively and quantitively. We also collected baseline clinical, echocardiography, and follow-up data.
RESULTS
Of the 397 patients with MR (52.4 ± 13.9 years), 117 (29.5%) were assigned to the PMI group, with 280 (70.5%) in the non-PMI group. PMI was demonstrated more in the posteromedial PM (PM-PM, 98/117) than in the anterolateral PM (AL-PM, 45/117). Compared with patients without PMI, patients with PMI had a decreased AL-PM (41.5 ± 5.4 vs. 45.6 ± 5.3)/PM-PM diastolic length (35.0 ± 5.2 vs. 37.9 ± 4.0), PM-longitudinal strain (LS, 20.4 ± 6.1 vs. 24.9 ± 4.6), AL-PM-LS (19.7 ± 6.8 vs. 24.7 ± 5.6)/PM-PM-LS (21.2 ± 7.9 vs. 25.2 ± 6.0), and increased inter-PM distance (25.7 ± 8.0 vs. 22.7 ± 6.2, all p < 0.001). Multiple logistic regression analyses identified male sex (odds ratio [OR] = 3.65, 95% confidence interval = 1.881-7.081, p < 0.001) diabetes mellitus (OR/95% CI/p = 2.534/1.13-5.68/0.024), AL-PM diastolic length (OR/95% CI/p = 0.841/0.77-0.92/< 0.001), PM-PM diastolic length (OR/95% CI/p = 0.873/0.79-0.964/0.007), inter-PM distance (OR/95% CI/p = 1.087/1.028-1.15/0.003), AL-PM-LS (OR/95% CI/p = 0.892/0.843-0.94/< 0.001), and PM-PM-LS (OR/95% CI/p = 0.95/0.9-0.992/0.021) as independently associated with PMI. Over a 769 ± 367-day follow-up, 100 (25.2%) patients had arrhythmia. Cox regression analyses indicated that PMI (hazard ratio [HR]/95% CI/p = 1.644/1.062-2.547/0.026), AL-PM-LS (HR/95% CI/p = 0.937/0.903-0.973/0.001), and PM-PM-LS (HR/95% CI/p = 0.933/0.902-0.965/< 0.001) remained independently associated with MR.
CONCLUSIONS
The CMR-derived PMI and LS parameters improve the evaluation of PM dysfunction, indicating a high risk for arrhythmia, and provide additive risk stratification for patients with MR.
Topics: Humans; Mitral Valve Insufficiency; Male; Female; Papillary Muscles; Retrospective Studies; Middle Aged; Magnetic Resonance Imaging, Cine; Myocardial Infarction; Prognosis; Follow-Up Studies; Aged
PubMed: 38953314
DOI: 10.1002/clc.24312 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Primary central nervous system vasculitis (PACNS) is a vasculitic disorder affecting small to medium-sized blood vessels primarily in the central nervous...
Primary central nervous system vasculitis (PACNS) is a vasculitic disorder affecting small to medium-sized blood vessels primarily in the central nervous system,involving the brain,spinal cord,and meninges.Tumor-like PNCAS,a rare subtype of PACNS,is often misdiagnosed as intracranial malignancy,and that with spinal cord involvement is even more uncommon.The lack of specific clinical symptoms and imaging manifestations poses a challenge to the diagnosis of PACNS.This report presents a case of tumor-like PACNS with spinal cord involvement based on the pathological evidence,aiming to enrich the knowledge about this condition.
Topics: Humans; Vasculitis, Central Nervous System; Female; Male; Spinal Cord; Middle Aged
PubMed: 38953273
DOI: 10.3881/j.issn.1000-503X.15762 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Intraspinal metastasis from malignant carcinomas in other body parts is rarely reported.Intraspinal metastases are often epidural,with primary tumors mostly from the...
Intraspinal metastasis from malignant carcinomas in other body parts is rarely reported.Intraspinal metastases are often epidural,with primary tumors mostly from the lung and prostate.The extramedullary subdural metastasis of thymic carcinoma is particularly rare and prone to misdiagnosis due to overlapping imaging features with primary intraspinal tumors.This article reports one case of intraspinal metastasis of thymic carcinoma,with the main diagnostic clues including a history of thymic carcinoma,fast growth rate,and irregular shape.
Topics: Humans; Thymus Neoplasms; Male; Thymoma; Spinal Neoplasms; Middle Aged
PubMed: 38953272
DOI: 10.3881/j.issn.1000-503X.15805 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Intestinal mantle cell lymphoma complicated with intussusception is rare in clinical practice,lacking specific clinical manifestations.CT and colonoscopy are helpful for...
Intestinal mantle cell lymphoma complicated with intussusception is rare in clinical practice,lacking specific clinical manifestations.CT and colonoscopy are helpful for the diagnosis of this disease,which need to be distinguished from colorectal cancer,Crohn's disease,and other pathological subtypes of lymphoma.The diagnosis still needs to be confirmed by pathological examination.This paper reports a case of intestinal mantle cell lymphoma complicated with ileocecal intussusception in an adult,aiming to improve the clinical and imaging doctors' understanding of this disease.
Topics: Humans; Lymphoma, Mantle-Cell; Intussusception; Male; Ileal Diseases; Intestinal Neoplasms; Middle Aged; Ileocecal Valve
PubMed: 38953271
DOI: 10.3881/j.issn.1000-503X.15783 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Long-term treatment of anemia involving frequent blood transfusions and intravenous iron administration increases the risks of hepatic iron overload and steatosis in the... (Review)
Review
Long-term treatment of anemia involving frequent blood transfusions and intravenous iron administration increases the risks of hepatic iron overload and steatosis in the patients undergoing hemodialysis.Pathological accumulation of iron damages hepatocytes,not only elevating the risks of progressive hepatic fibrosis and cirrhosis but also potentially accelerating the process of hepatic steatosis.Iron overload and steatosis may interact with each other,exacerbating liver damage and ultimately leading to further deterioration of hepatic fibrosis and cirrhosis.MRI characterized by non-invasiveness and high repeatability,enables the simultaneous quantitative assessment of hepatic iron and fat content,providing crucial information for early diagnosis and intervention of liver diseases.In recent years,researchers have achieved significant advances in the application of MRI in the diagnosis and treatment of liver diseases.MRI can accurately reflect the extent of hepatic iron overload and steatosis in patients and predict the risk of liver diseases.This article reviews the latest advances,challenges,and perspectives in the application of MRI in assessing hepatic iron overload and steatosis in the patients undergoing hemodialysis,aiming to offer valuable references for clinical practice.
Topics: Humans; Iron Overload; Magnetic Resonance Imaging; Renal Dialysis; Fatty Liver; Liver
PubMed: 38953270
DOI: 10.3881/j.issn.1000-503X.16066 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Objective To analyze the research progress and hot topics in hypertrophic cardiomyopathy from 2018 to 2022.Methods The publications in the field of hypertrophic...
Objective To analyze the research progress and hot topics in hypertrophic cardiomyopathy from 2018 to 2022.Methods The publications in the field of hypertrophic cardiomyopathy from January 1,2018 to December 31,2022 were retrieved from Web of Science core collection database and included for a bibliometric analysis.Results A total of 6355 publications were included,with an average citation frequency of 7 times.The year 2021 witnessed the most publications (1406).The analysis with VOSviewer showed that the research on sudden death related to hypertrophic cardiomyopathy,especially the predictive value of late gadolinium-enhanced cardiac MRI in sudden death,was a hot topic.In addition,gene detection and the new drug mavacamten became hot research topics.The United States was the country with the largest number of publications and the highest citation frequency in this field.Chinese scholars produced the second largest number of publications,which,however,included few high-quality research results.Conclusions Risk stratification and prevention of sudden death is still an important and hot research content in the field of hypertrophic cardiomyopathy.Chinese scholars should carry out multi-center cooperation in the future to improve the research results.
Topics: Cardiomyopathy, Hypertrophic; Humans; Bibliometrics; Death, Sudden, Cardiac; Publications; China
PubMed: 38953261
DOI: 10.3881/j.issn.1000-503X.15892 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2024Objective To explore the diagnostic value of ultrasound for thyroid nodules with a spoke-wheel blood flow pattern.Methods The clinical data of the patients with thyroid...
Objective To explore the diagnostic value of ultrasound for thyroid nodules with a spoke-wheel blood flow pattern.Methods The clinical data of the patients with thyroid nodules presenting a spoke-wheel blood flow pattern examined by ultrasound were collected,and the gray-scale ultrasound features of the nodules were recorded.The diagnostic performance of the Thyroid Imaging Reporting and Data System by American College of Radiology (ACR TI-RADS),Chinese Thyroid Imaging Reporting and Data System (C-TIRADS),and combined specific indicators for the thyroid nodules with a spoke-wheel blood flow pattern was evaluated by comparison with the pathological results,which was regarded as the gold standard.Results A total of 64 patients with thyroid nodules were finally included,including 47 patients with malignant nodules and 17 patients with benign nodules.In addition to the general ultrasound features,central scar mostly appeared in malignant nodules (=5.968,=0.015),while central coarse calcification was more common in benign nodules (=10.899,=0.001).After the combination of central scar and central gross calcification,the diagnostic performance of ACR TI-RADS and C-TIRADS was improved (both <0.001).Conclusions When the thyroid nodule shows a spoke-wheel blood flow pattern,one should be cautious of the possibility of malignancy.Combining central scar and central coarse calcification can improve the accuracy of ultrasonic diagnosis.
Topics: Humans; Thyroid Nodule; Middle Aged; Male; Female; Ultrasonography; Adult; Aged; Young Adult
PubMed: 38953260
DOI: 10.3881/j.issn.1000-503X.15894 -
Indian Journal of Ophthalmology Jul 2024
Topics: Humans; Fovea Centralis; Tomography, Optical Coherence; Fluorescein Angiography; Visual Acuity; Male; Fundus Oculi; Female
PubMed: 38953129
DOI: 10.4103/IJO.IJO_2749_23