Poster: ECR 2020 / C-14478 / Role of Cardiac Magnetic Resonance and Early Speckle-tracking Echocardiography in the prediction of Left Ventricle Remodeling after Acute ST-segment Elevation Myocardial Infarction by: E. Chiodi1, A. Cossu2, F. Pellegrino 1, L. Marchetti1, A. Squerzanti1, A. Carnevale1, M. Giganti1, G. Benea3; 1Ferrara/IT, 2Ferrara, Fe/IT, 3Lagosanto (FE)/IT

PURPOSE:To evaluate the ability of coronary computed tomography angiography (CCTA) with model-based iterative reconstruction (MBIR) algorithm in detecting significant coronary artery stenosis compared with invasive coronary angiography (ICA).MATERIAL AND METHODS:We retrospectively identified 55 patients who underwent CCTA using the MBIR algorithm with evidence of at least one significant stenosis (≥ 50%) and an ICA within three months. Patients were stratified based on calcium score; stenoses were classified by type and by coronary segment involved. Dose-length-product was compared with the literature data obtained with previous reconstruction algorithms. Coronary artery stenosis was estimated on ICAs based on a qualitative method.RESULTS:CCTA data were confirmed by ICA in 89% of subjects, and in 73% and 94% of patients with CS < 400 and ≥ 400, respectively. ICA confirmed 81% of calcific stenoses, 91% of mixed, and 67% of soft plaques. Both the dose exposure of patients with prospective acquisition (34) and the exposure of the whole population were significantly lower than the standard of reference (p < 0.001 and p = 0.007).CONCLUSIONS:CCTA with MBIR is valuable in detecting significant coronary artery stenosis with a solid reduction of radiation dose. Diagnostic performance was influenced by plaque composition, being lower compared with ICA for patients with lower CAC score and soft plaques; the visualisation of an intraluminal hypodensity could cause false positives, particularly in D1 and MO segments.

PURPOSE:To assess the current status of patient's informed consent (PIC) management at radiological centres and the overall opinion of radiologist active members of the Italian Society of Medical Radiology (SIRM) about PIC dematerialisation through an online survey.METHODS AND MATERIALS:All members were invited to join the survey as an initiative by the Imaging Informatics Chapter of SIRM. The survey consisted of 11 multiple-choice questions about participants' demographics, current local modalities of PIC acquisition and storage, perceived advantages and disadvantages of PIC dematerialisation over conventional paper-based PIC, and overall opinion about PIC dematerialisation.RESULTS:A total of 1791 radiologists (amounting to 17.4% of active SIRM members for the year 2016) joined the survey. Perceived advantages of PIC dematerialisation were easier and faster PIC recovery (96.5%), safer storage and conservation (94.5%), and reduced costs (90.7%). Conversely, the need to create dedicated areas for PIC acquisition inside each radiological unit (64.0%) and to gain preliminary approval for the use of advanced digital signature tools from patients (51.8%) were seen as potential disadvantages. Overall, 94.5% of respondents had a positive opinion about PIC dematerialisation.CONCLUSION:Radiologists were mostly favourable to PIC dematerialisation. However, concerns were raised that its practical implementation might face hurdles due to its complexity in current real life working conditions.

BACKGROUND:We present a rare case of anomalous origin of the left coronary artery from the pulmonary artery syndrome in an elderly man, and we describe coronary computed tomographic angiographic imaging findings to improve diagnostic confidence for the evaluation of this uncommon coronary artery anomaly.CASE PRESENTATION:A 70-year-old Caucasian man came to our hospital with slight limitation of physical activity (New York Heart Association class II). He was asymptomatic for angina, syncope, and palpitations. Cardiac magnetic resonance imaging was performed after echocardiography because a hypertrophic cardiomyopathy was suspected; a plausible coronary artery anomaly was demonstrated as collateral evidence. Subsequently, coronary computed tomographic angiography showed the anomalous origin of left coronary artery from the pulmonary artery; the coronary vessels appeared markedly dilated and tortuous. Dilated intercoronary vessels along the epicardial surface of the heart and dilated bronchial arteries, corresponding to collateral pathways, were observed. Left ventricular hypertrophy, delayed subendocardial enhancement, and mitral insufficiency were better evaluated on magnetic resonance images. Invasive coronary angiography confirmed the main findings. Given the patient's age and clinical performance, surveillance with medical management was considered appropriate, and surgical repair was avoided.CONCLUSIONS:Confidence with the anatomic pattern and clinical significance of this anomalous condition is necessary to improve cardiac imaging evaluation ability. In our patient, coronary computed tomographic angiography proved to be a reliable imaging approach, superior to invasive coronary angiography in terms of diagnostic performance and patient safety.

Poster: ECR 2017 / B-0201 / Diagnostic performance and influence on computer-assisted-diagnosis (CAD) of ultra-low dose CT colonography (ULD-CTC) with model-based iterative reconstruction (MBIR) by: G. De Paoli Barbato , M. Bassi, E. Raimondi, A. Spiller, R. Rizzati, M. tilli, M. Giganti, G. Benea; Ferrara/IT

The aim of this article was to illustrate a case of primary septic arthritis of the manubriosternal joint, due to Staphylococcus aureus infection, in an immunocompetent 28-year-old male patient. The manubriosternal joint can be rarely involved in inflammatory processes, but pyarthrosis is even more unusual in an otherwise healthy adult. Although rare, pyarthrosis could be associated with significant morbidity and mortality, first of all because of spreading to mediastinal structures. Diagnosis is generally made thanks to imaging findings after clinical suspicion in a patient with anterior chest pain and swelling, fever, and raised inflammatory markers, especially when any risk factors are known. Management is generally aggressive because intravenous antibiotics and surgical debridement are necessary.

Poster: ECR 2017 / C-0602 / CARDIAC AMYLOIDOSIS: literature review and MRI characteristics by: M. macchia 1, D. De Falco Alfano1, F. Coppola2, R. Righi3, M. Zerbini3, M. Giganti3, G. Benea4; 1Cona (FE)/IT, 2Lecce/IT, 3Ferrara/IT, 4Lagosanto (FE)/IT

To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses.

To differentiate left ventricle non-compaction (LVNC) from hypertrabeculated myocardium due to LV remodeling in β-thalassemia major (β-TM) patients, cardiac magnetic resonance (CMR) images of 38 β-TM patients and 10 LVNC patients were compared using 3 diagnostic criteria: ratio of diastolic segmental non-compacted to compacted myocardium (NC/C ratio) >2.5, percentage of non-compacted LV mass (NC-LVM%) >20% and >25% of global LV mass. Specificity of NC/C ratio of >2.5 was the lowest (58%) and of NC-LVM% of >25% the highest (93%). A NC-LVM% >20% showed sensitivity 100% and specificity 87%. Disease differentiation depends on the selected CMR criterion and is better with NC-LVM%.

Poster: ESCR 2017 / P-0075 / Diagnosis of ALCAPA syndrome in a asymptomatic 70-years-old man by Computed Tomography: Imaging Findings by: P. Cucchi 1, M. Zerbini1, R. Righi1, A. Vizzuso1, M. Macchia1, M. Giganti1, G. Benea2; 1Ferrara/IT, 2Lagosanto/IT

Poster: ECR 2017 / C-1664 / Prevalence of pulmonary embolism (PE) in hospitalized and emergency department (ED) patients of an urban teaching hospital. Is there an overuse of Computed Tomography Pulmonary Angiography in the ED? by: C. Montalto1, F. Ermili2, S. Tartari1, G. Benea 3; 1FERRARA/IT, 2Ferrara, Fe/IT, 3Lagosanto (FE)/IT

AIMS:Assessment of left ventricular (LV) transmural scar tissue in clinical practice is still challenging because magnetic resonance imaging (MRI) and nuclear techniques have limited access and cannot be performed extensively. The aim of this study was to verify whether parametric two-dimensional speckle-tracking echocardiography (2D-STE) can more accurately localize and quantify LV transmural scar tissue in patients with healed myocardial infarct (MI) in comparison with MRI.METHODS AND RESULTS:Thirty-one consecutive patients (age 56 ± 32 years, 29 males) with MRI and echocardiography performed after at least 6 months from an acute MI were studied. Apical LV longitudinal strain images by 2D-STE and short-axis contrast images by MRI were analysed to generate parametric bull's eye maps showing the distribution of the LV transmural scar tissue, whose extension was measured by planimetry and expressed as a percentage of the total myocardial area. Twelve patients also had early 2D-STE and MRI examinations after the acute MI. 2D-STE accurately quantified the extent of transmural scar tissue vs. MRI (r = 0.86; limits of agreement 10.0 and -9.5%). Concordance between 2D-STE and MRI for transmural scar tissue localization was high, with only 3.6% of discordant segments using an LV 16-segment model. Lin coefficients, intra-class correlation coefficients, and Bland-Altman analysis showed very good intra- and inter-observer reproducibility for 2D-STE evaluations. The transmural scar tissue area at 6 months could be predicted by early 2D-STE evaluation.CONCLUSION:2D-STE polar plots of LV longitudinal strain characterize transmural scar tissue accurately compared with MRI and may facilitate its assessment in clinical practice.

PURPOSE: In polytraumatized patients with active bleeding, the improvement of survival depends on control/early stoppage of bleeding. The purpose of our study was to define the role of MDCT in patients with hemothorax. MATERIALS AND METHODS: From January 2008 to December 2013, we performed thoraco-abdominal CT to 1352 patients with polytrauma or thoracic blunt trauma. We retrospectively reviewed CT of 93 patients (mean age 65 years) where MDCT showed hemothorax. Basing on CT findings, 12 patients have been treated with interventional radiology, 78 patients with surgical procedures (drainage tube, VATS, thoracotomy). RESULTS: CT showed rib fractures in 85 patients; an active bleeding in arterial phase, with associated hematic pleural effusion in 12 patients;2 pseudoaneurysm in 2 patients. Two patients with flail chest showed bleeding a few days after traumatic event. Nine patients underwent to percutaneous treatment with technical success in 9/10 (90%). CONCLUSIONS: MDCT demonstrates high value in the management of patients with thoracic blunt trauma, identifying and classifying the severity of injuries. It shows high accuracy in the diagnosis of active bleeding and precludes the occurrence of complications. In the detection of active bleeding CT allows correct selection and safe treatment planning. In polytraumatized patients the selective arteriography and transcatheter embolization provide a viable diagnostic and therapeutic alternative in the management of bleeding from arterial lesions.

The aim of this article was to present our experience with CT-colonography evaluation of a case of giant colonic diverticulum. Despite the high prevalence of diverticular disease in the Western world, giant colonic diverticula are rare entities, with fewer than 200 cases reported in literature.

AIMS:Up to 30-45% of implanted patients are non-responders to CRT. We evaluated the role of a 'CRT team' using cardiac magnetic resonance (CMR) and longitudinal myocardial strain to identify the target area defined as the most delayed and viable region for LV pacing. METHODS AND RESULTS:A total of 100 heart failure patients candidates for CRT divided into two groups were enrolled. Group 1 consisted of 50 consecutive patients scheduled for CRT and prospectively included. Group 2 (control) consisted of 50 patients with a CRT device implanted according to standard clinical practice and matched for age, sex, and LVEF with group 1. Patients were evaluated at baseline and at 6-month follow-up. In group 1, patients underwent two-dimensional speckle-tracking assessment of longitudinal myocardial strain and CMR imaging to identify the target area for LV lead pacing. A positive response to CRT was defined as a reduction of ≥15% of the LV end-systolic volume at 6-month follow-up. A total of 39 (78%) patients of group 1 were classified as responders to CRT whilst in group 2, only 28 (56%) were responders (P = 0.019). The 'CRT team' identified as target for LV pacing the lateral area in 30 (60%) patients, and the anterolateral or posterolateral areas in 12 (24%) patients. In 8 (16%) patients, the target was far from the lateral area, in the anterior or posterior areas. The patients with concordant position exhibited the highest positive response (93.1%) to CRT. CONCLUSIONS:Multimodality cardiac imaging as a guide for CRT implantation is useful to increase response rate.