The soleus arcade syndrome is a rare compression neuropathy of the tibial nerve that often remains undiagnosed due to low clinical awareness and difficult diagnosis. We present the case of a female patient admitted with acute worsening of a pre-existing sensory tibial neuropathy and acute tibial nerve palsy after knee joint injection. After a knee magnetic resonance imaging remained non-diagnostic, dynamic ultrasonography was performed. Constriction by the soleus arcade and proximal swelling of the tibial nerve could be demonstrated during plantarflexion of the ankle by means of a dynamic examination in the standing patient. The patient underwent surgery and recovered fully. This proposed diagnostic approach can be used to identify soleus arcade syndrome by ultrasound.

The present study was aimed to assess epi- and endocardial ventricular electroanatomical activation during cardiac resynchronization therapy (CRT) by means of non-invasive imaging of cardiac electrophysiology (NICE) in a patient with a novel quadripolar LV lead.Non-invasive imaging of cardiac electrophysiology is a novel imaging tool which works by fusing data from high-resolution electrocardiogram (ECG) mapping with a model of the patient's individual cardiothoracic anatomy created from magnetic resonance imaging. This was performed in a cardiac resynchronization therapy defribrillator (CRT-D) patient with a quadripolar left ventricular (LV) lead. Beat-to-beat endocardial and epicardial ventricular activation sequences were computed using NICE during intrinsic conduction as well as during different pacing modes with different LV and biventricular (biV) pacing vectors. The spatial resolution of NICE enabled discrimination of the different pacing vectors during LV and biV pacing. Biventricular pacing resulted in a marked shortening of the total activation duration (TAD) of both ventricles when compared with intrinsic conduction and RV and LV pacing.Non-invasive imaging of cardiac electrophysiology facilitates non-invasive imaging of ventricular activation, which may be useful in CRT patients to locate the area of latest ventricular activation as the target area for LV lead placement. Moreover, especially in non-responders to CRT NICE may be further useful to determine the best electrical repositioning option.

Objectives We sought to assess the relation of late microvascular obstruction (l-MVO) size as quantified by cardiac magnetic resonance (CMR) imaging with cardiac and inflammatory marker concentrations after acute myocardial infarction (AMI). Methods CMR was performed in 118 consecutive patients within 8days after successful interventional reperfused first acute ST-elevation AMI. Infarct volumes and l-MVO sizes were calculated from late enhancement (LE) sequences and functional parameters were determined from short-axis cine MR sequences. Creatine kinase (CK) and cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP) as well as lactate dehydrogenase (LD) concentrations were determined serially from day 1 to day 4 after symptom onset. Results L-MVO was detected in 66/118 patients (55.9%) and comprised 18.2±10% of infarct size and 4.7±3% of left ventricle myocardial mass. Each single-point, peak and cumulative release concentration of cTnT (r=0.44 to 0.73, p<0.0001), CK (r=0.21 to 0.76, p<0.0001), LD (r=0.36 to 0.82, all p<0.0001) as well as hs-CRP single-point values as assessed from day 1 to day 4 and its peak and cumulative release concentrations (r=0.24 to 0.49, p<0.003) significantly correlated with l-MVO size. Receiver operating curve (ROC) analysis indicated a cut-off value of 4.7μg/l cTnT to best identify the presence of l-MVO (area under the curve (AUC) 0.904; 95% CI: 0.85–0.95; p<0.0001). Conclusion L-MVO sizes significantly correlate with cardiac and inflammatory marker concentrations as determined early after AMI. cTnT concentration of >4.7μg/l could help to identify patients in whom l-MVO is present.

Fig. S1 Gas inclusions in the musculature of the right limb shown by (a) ultrasound, (b) X-ray, and (c) computed tomography. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The aim of the study was to find out if single time point and estimated cumulative release of cardiac troponin T (cTnT) and creatine kinase (CK) correlate with early infarct size and left ventricular function measured by cardiac magnetic resonance (CMR).

Background Little is known about the effect of cardiac resynchronization therapy (CRT) on endo- and epicardial ventricular activation. Noninvasive imaging of cardiac electrophysiology (NICE) is a novel imaging tool for visualization of both epi- and endocardial ventricular electrical activation. Methodology/Principal Findings NICE was performed in ten patients with congestive heart failure (CHF) undergoing CRT and in ten patients without structural heart disease (control group). NICE is a fusion of data from high-resolution ECG mapping with a model of the patient's individual cardiothoracic anatomy created from magnetic resonance imaging. Beat-to-beat endocardial and epicardial ventricular activation sequences were computed during native rhythm as well as during ventricular pacing using a bidomain theory-based heart model to solve the related inverse problem. During right ventricular (RV) pacing control patients showed a deterioration of the ventricular activation sequence similar to the intrinsic activation pattern of CHF patients. Left ventricular propagation velocities were significantly decreased in CHF patients as compared to the control group (1.6±0.4 versus 2.1±0.5 m/sec; p<0.05). CHF patients showed right-to-left septal activation with the latest activation epicardially in the lateral wall of the left ventricle. Biventricular pacing resulted in a resynchronization of the ventricular activation sequence and in a marked decrease of total LV activation duration as compared to intrinsic conduction and RV pacing (129±16 versus 157±28 and 173±25 ms; both p<0.05). Conclusions/Significance Endocardial and epicardial ventricular activation can be visualized noninvasively by NICE. Identification of individual ventricular activation properties may help identify responders to CRT and to further improve response to CRT by facilitating a patient-specific lead placement and device programming.

PURPOSE:To assess the relation of cardiac troponin T (cTnT) and creatine kinase (CK) release with infarct size and left ventricular function evaluated during the subacute phase as well as four months after acute myocardial infarction (AMI) by contrast-enhanced MRI (CE-MRI). MATERIALS AND METHODS:CMR of 80 patients (68 male, mean age 54.2 ± 11.7 years) was performed within 8 days and 4 months after first acute ST-elevation AMI with successful primary angioplasty. CK and cTnT concentrations were determined serially from admission to day 4 after symptom onset. RESULTS:All single time-points, estimated average release and peak concentrations of CK and cTnT markers correlated significantly with acute and mid-term infarct size (r = 0.43 to 0.79, all P < 0.001), ejection fraction (EF%) (r = -0.42 to -0.58, all P < 0.002) as well as with end-systolic volume (ESV) (r = 0.32 to 0.57, all P < 0.002) at all times of assessment. Patients with cTnT concentrations below the cutoff value of 3.26 μg/L measured 48 h after AMI-related symptom onset had a significant improvement in global (EF: P < 0.0001) myocardial function during the study period, whereas in those with cTnT ≥ 3.26 μg/L, functional recovery did not occur (P = 0.09). CONCLUSION:All single, mean and maximum concentrations of cTnT and CK measured within the first 4 days after AMI permit an accurate prediction of infarct size and left ventricular function as determined in the acute phase as well as four months after AMI by CE-MRI.

The computational reconstruction of cardiac activation times in a noninvasive manner was performed in ten patients with congestive heart failure (CHF), complete left bundle branch block (LBBB) patients undergoing cardiac resynchronization therapy (CRT) and ten patients without structural heart disease undergoing an EP study (control group).

To find out whether calcium scoring of the coronary arteries (CAC scoring) could be carried out with a CT angiography of the coronary arteries (CTCA) in a single CT data acquisition. The Agatston and V130 scores for 113 patients were assessed. A calcium volume score (V600 score) was compiled from the CTCA data sets. Intra- and interobserver correlations were excellent (rho > 0.97). The intra- and interobserver repeatability coefficients were extremely low, increasing in magnitude from the V600 score to the V130 and Agatston scores. The V600 score underestimates the coronary calcium burden. However, it has a linear relation to the Agatston and V130 scores. Thus, they are predictable from the values of the V600 score. The V600 score shows a linear relation to the classic CAC scores. Due to its extremely high reliability, the score may be a feasible alternative for classic CAC scoring methods in order to reduce radiation dosages.

BACKGROUND:We report on a case of an impar umbilical artery (IUA) in an 18-year-old woman. CASE PRESENTATION:The aorta branched off at level L2 into a ventral IUA and a dorsal aorta. The strong IUA produced the inferior mesenteric artery (IMA), the renal artery of a left-sided duplex kidney, and the right-sided ovarian artery before it turned to the right to merge into the right common iliac artery. From the aorta arose the lumbar arteries, the median sacral artery, lateral sacral arteries, and iliolumbar arteries before it turned to the left. Both vessels were connected by an artery 0.8 cm in diameter running infraperitoneal, from the left side of which the uterine artery arose for a left paramedian uterus didelphys. CONCLUSION:This anatomical situation is presented for the first time using an arterial contrast enhanced CT and is discussed within the context of previously known cases.

Objectives The purpose of this study was to compare cardiovascular magnetic resonance (CMR) and echocardiography (echo) in patients treated with primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) with emphasis on the analysis of left ventricular function and left ventricular wall motion characteristics. Methods We performed CMR and echo in 52 patients with first AMI shortly after primary angioplasty and four months thereafter. CMR included cine-MR and T1-weighted first-pass and late-gadolinium enhancement (LGE) sequences. Global ejection fraction (EF CMR , %) and regional left ventricular function (systolic wall thickening %, [SWT]) were determined from cine-MR images. In echo the global left ventricular function (EF echo , %) and regional wall motion abnormalities were determined. A segment in echo was scored as "infarcted" if it was visually > 50% hypokinetic. Results EF echo revealed a poor significant agreement with EF CMR at baseline (r: 0.326; p < 0.01) but higher correlation at follow-up (r: 0.479; p < 0.001). The number of infarcted segments in echocardiography correlated best with the number of segments which showed systolic wall thickening < 30% (r: 0.498; p < 0.001) at baseline and (r: 0.474; p < 0.001) at follow-up. Improvement of EF was detected in both CMR and echocardiography increasing from 44.2 ± 11.6% to 49.2 ± 11% (p < 0.001) by CMR and from 51.2 ± 8.1% to 54.5 ± 8.3% (p < 0.001) by echocardiography. Conclusion Wall motion and EF by CMR and echocardiography correlate poorly in the acute stage of myocardial infarction. Correlation improves after four months. Systolic wall thickening by CMR < 30% indicates an infarcted segment with influence on the left ventricular function.

Objectives: The aim of the present study was to monitor the microvascular perfusion damage in the acute and chronic stage after myocardial infarction (MI) using first-pass dynamic magnetic resonance imaging (MRI). Furthermore we compared improvement of myocardial microcirculation and function in infarcted and non-infarcted left midventricular segments over a 4 months period.Materials and methods: Cardiac magnetic resonance imaging (CMR) was performed in 46 consecutive patients within 8 days after successful reperfused first acute ST-elevation MI and 4 months thereafter. First-pass images were obtained by using Turbo-FLASH sequence during a bolus injection of Gd-based contrast agent. Signal-intensity-to-time (SIT) curves of 276 left ventricular myocardial segments were generated. Furthermore, infarct volumes as well as parameters of regional left ventricular function of corresponding segments were calculated.Results: SIT curves highly significantly correlate with MI size (r = -0.57, r = -0.43 respectively; all p < 0.0001) as well as with segmental wall thickening (SWT) of corresponding segments at baseline and follow-up scans (r = 0.20, r = 0.15 respectively; all p < 0.02). SWT differ highly significantly between segments with and those without LE at baseline (p < 0.003) and follow-up examinations (p < 0.008), presenting either clear improvements at follow-up (all p < 0.0001). In contrast, infarcted segments showing microvascular obstruction evidenced neither significant recovery of SIT nor of SWT (p = NS).Conclusion: Our data indicate a close relationship between MI size and myocardial perfusion as well as function. Beyond epicardial artery patency, the assessment of quantitative parameters of myocardial perfusion and contractile function with the help of CMR appears to be a useful tool for estimating myocardial recovery after acute MI. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

To analyse the morphological appearance of horseshoe kidneys (HKs) and crossed fused ectopia (CFE) and to assess the frequency and clinical significance of associated anomalies and diseases.The findings and images of 209 patients with fused kidneys (FKs) were reviewed; in all, 244 scans from computed tomography (CT), 233 ultrasonograms and 89 micturition cysto-urethrograms, urograms, magnetic resonance images and angiograms were taken.HKs (found in one of 474 abdominal CT scans) and CFEs (found in one of 3078 CT scans) showed a high variability of vasculature that could not be classified. However, some generalized conclusions were possible about the renal vasculature (430 arteries in 103 kidneys). Variants of the most cephalad artery of both sides were rare. The second artery on the right had a pre-caval course. The origins of vessels located further caudal were more ventral. CFEs were anatomically different from HKs with respect to lower position, greater axial rotation, smaller pelvic width, more caudal origin, and fewer vessels, but not in accompanying anomalies. Severe anomalies or malformations were found in 23% of patients, with half of them in the urogenital system. Malformations were found considerably more often in children than in adults. There was no increased incidence of diseases such as stones or inflammation of the renal pelvis.Concomitant anomalies and diseases were equally frequent for HK and CFE, but less frequent than generally assumed. Individual cases of complex anatomical situations require special examination strategies, and CT appears to be the most reliable imaging method.

This is a report of a case of a 26-year-old patient suffering from progressive renal insufficiency with a neurogenic bladder disorder due to a lipomyelomeningocele. She had renal agenesis on the left side and grade III hydronephrosis of both segments of a right duplex kidney with a bifid ureter joining further distal to the kidney. Both ureters were dilated. The cause was found to be a yo-yo reflux between the two halves of the kidney. Following bladder augmentation and pyelopyelostomy, renal insufficiency improved to stage III and has now been stable for four years. Due to the contralateral renal agenesis, the case is a unique illustration of the functional effect of the yo-yo reflux and pyelopyelostomy.

Kurzfassung: Motivation: Im Rahmen der vorliegenden Studie sollte der quantitative Zusammenhang zwischen der Ischamiezeit „(pain-to-balloon time“) und der Erholung der linksventrikularen regionalen Funktion nach primarer PTCA akuter Myokardinfarkte mittels kardialer MRT geklart werden. Methoden: Wir fuhrten sowohl Cine- als auch Late-Enhancement- (LE-) MRT-Untersuchungen an 40 Patienten mit erstem Myokardinfarkt kurz nach Wiederherstellung eines TIMI-3-Flusses sowie 4 Monate danach durch. Infarzierte Segmente wurden anhand der LE-Kurzachsenschnitte definiert. Die Parameter der regionalen Wandbewegung wurden anhand der Kurzachsen-Cine-Aufnahmen quantifiziert. Die Einteilung der Segmente folgte dem AHA17-Segmentemodell. Es wurden Patientengruppen mit einer Ischamiezeit von 12 Stunden gebildet. Ergebnisse: Von 640 untersuchten Segmenten zeigten 335 (52 %) eine Signalverstarkung 15 min. nach Kontrastmittelgabe im Sinne eines LE sowie eine konsekutiv erniedrigte regionale Wandbewegung („segmental wall thickening“ [SWT] 49 ± 2 % vs. 60 ± 2 % bei ubrigem Myokard; p < 0,01). Bemerkenswerterweise unterschieden sich die mittlere maximale Transmuralitat sowie die Baseline-SWT innerhalb der Gruppen nicht signifikant. Es zeigte sich jedoch nur in den Gruppen, welche innerhalb von 6 Stunden reperfundiert wurden, eine signifikante Zunahme der regionalen Wandverdickung (p < 0,001). Im Follow-up zeigte sich eine signifkant verbesserte Wandbewegung bei fruher Reperfusion innerhalb von 3 Stunden (< 3 h: 74 ± 4 %; 3–6 h: 57 ± 4 %; 6–12 h: 48 ± 7 %; < 3 bis 3–6 h: p < 0,003 und < 3 bis 6–12 h: p < 0,001). Ebenso zeigte sich in dieser Gruppe eine deutlich hohere Zunahme der regionalen Funktion (< 3 h: +21 ± 3 %; 3–6 h: +8 ± 4 %; 6– 12 h: +6 ± 3 %; < 3 h bis 3–6 h und 6–12 h; p < 0,02). Schlussfolgerung: Es konnten erstmals mittels kardialer MRT die quantitativen Auswirkungen fruher Reperfusion bei akuten Myokardinfarkten mittels primarer-PTCA gezeigt werden.

Poster: ECR 2008 / C-360 / Clinical and radiological analysis of 209 cases of crossed fused ectopia and horseshoe kidney by: J. Petersen , C. Schenk, P. Rehder, T. Trieb, B. Glodny; Innsbruck/AT