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ABSTRACT: Intramural haematoma (IMH) is a localised haemorrhage within the aortic wall. Imaging plays a central role in diagnosing IMH, differentiating it from aortic dissection (AD) and assessing for complications. Imaging is also important for prognostication and to help guide clinical decision making as a number of imaging characteristics have been correlated with increased mortality rates including location, mural thickness and aortic diameter. Multidetector CT is the leading technique for diagnosis and classification of IMH owing to speed of image acquisition, multiplanar capabilities and excellent spatial resolution. MRI is rarely used to investigate the initial presentation of IMH but is frequently used for serial follow-up studies. The clinical outcome of IMH may be favourable, with spontaneous regression over time, or it may be complicated by pericardial tamponade, aortic regurgitation and development of AD. Early surgical management is the treatment of choice for patients with Stanford type A IMH whereas most patients with Stanford type B IMH have a good short-term outcome with aggressive control of hypertension. This article reviews the pathogenesis, clinical features and complications of IMH as well as the role of advanced imaging techniques in its evaluation.
Postgraduate medical journal 09/2012; 88(1045):661-7. · 1.38 Impact Factor
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ABSTRACT: OBJECTIVE: This article reviews the spectrum of disease processes that may involve the aortic root with particular emphasis on the role of cardiovascular MRI and MDCT angiography in their assessment. Key MRI and MDCT imaging findings are discussed and illustrated. CONCLUSION: Radiologists should be aware of the spectrum of disease processes that may involve the aortic root and their appearances at MRI and MDCT angiography.
American Journal of Roentgenology 08/2012; 199(2):W175-86. · 2.78 Impact Factor
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ABSTRACT: Sinus of Valsalva aneurysms (SVAs) are uncommon but important entities. They are most often congenital in origin, resulting from incomplete fusion of the aortic media to the aortic valve annulus. Less frequently, they may be acquired, usually secondary to infective endocarditis. Unruptured aneurysms may be clinically silent and diagnosed incidentally, but can also produce symptoms as a consequence of mass effect on related structures. Rupture may present with sudden hemodynamic collapse but can have a more insidious onset depending upon the site and size of the perforation. Early diagnosis is imperative and can usually be made reliably by transthoracic echocardiography. However, transesophageal echocardiography may sometimes be required for confirmation. Cardiovascular magnetic resonance imaging (CMRI) and multi-detector computed tomography are being increasingly utilized for evaluation of SVAs and can offer valuable complimentary information. CMRI in particular enables a comprehensive assessment of anatomy, function and flow in a single sitting. Surgical repair forms the mainstay of treatment for both ruptured and unruptured aneurysms and has low complication rates. This article provides an overview of the pathological and clinical aspects of SVAs and discusses in detail the role of advanced imaging modalities in their evaluation.
The international journal of cardiovascular imaging 01/2012; 28(7):1725-38. · 2.15 Impact Factor
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Edward T D Hoey
Postgraduate medical journal 07/2011; 87(1029):443-4. · 1.38 Impact Factor
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ABSTRACT: OBJECTIVE: This article reviews the role of cardiovascular MRI in the diagnosis and characterization of the spectrum of infectious and inflammatory disorders of the heart. An imaging protocol is described, and typical MRI findings are discussed and illustrated. CONCLUSION: Radiologists should be aware of the spectrum of infectious and inflammatory conditions that can affect the heart and the role of MRI in conjunction with other imaging techniques in their assessment.
American Journal of Roentgenology 07/2011; 197(1):103-12. · 2.78 Impact Factor
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Edward T D Hoey
Postgraduate medical journal 03/2011; 87(1025):163-4. · 1.38 Impact Factor
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ABSTRACT: This study assessed the utility of dual-energy pulmonary CT angiography (CTA) for noninvasive assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Regional perfusion abnormalities were correlated with hemodynamic parameters and structural abnormalities on pulmonary CTA.
Twenty patients with CTEPH (11 men and nine women; mean age, 61.5 years) underwent pulmonary CTA with a dual-energy technique. Right heart catheterization data were available in 15 cases. Scan parameters were as follows: tube A, 140 kV (75 mA); tube B, 80 kV (300 mA); gantry rotation, 500 milliseconds; pitch, 0.5; and collimation, 14 × 1.2 mm. An iodine map was generated via three-material-decomposition and was scored for extent of hypoperfusion. Correlation was made with mosaic attenuation pattern, extent of vascular obstruction, and right heart hemodynamics. Iodine attenuation values were analyzed within completely occluded, partially occluded, and disease-free lobes.
A strong correlation existed between dual-energy CT-derived perfusion and mosaic attenuation pattern when both lobar (r > 0.6; n = 20; p < 0.006) and whole-lung scores were assessed (r = 0.77; n = 20; p < 0.001). There was no statistically significant correlation between dual-energy CT perfusion and vascular obstructive index, mean pulmonary artery pressure, or pulmonary vascular resistance (p > 0.08). Of 42 completely occluded lobes, 27 (64%) had demonstrable residual perfusion (mismatching), suggesting that blood supply was maintained via systemic collaterals.
Dual-energy CT can offer a "one-stop" assessment of anatomy and perfusion in CTEPH. The additional information provided by dual-energy CT could have a future role in helping guide patient selection for thromboendarterectomy surgery.
American Journal of Roentgenology 03/2011; 196(3):524-32. · 2.78 Impact Factor
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ABSTRACT: OBJECTIVE: There is an increasing demand for MR angiography (MRA) techniques that do not require the administration of exogenous contrast material. Fresh blood imaging utilizes an ECG-gated fast spin-echo sequence to acquire images in both the systolic and diastolic phases of the cardiac cycle. Fast systolic arterial flow is differentiated from slower diastolic flow and a subtraction technique is used to produce angiographic images. We describe the technical aspects of performing lower extremity MRA and illustrate some sample cases. CONCLUSION: Fresh blood imaging is an emerging unenhanced MRA technique that has recently become commercially available. Early clinical trials appear promising and it is anticipated that fresh blood imaging will become invaluable, particularly in patients with impaired renal function. Technical refinements are still required to perfect this novel MR application, particularly for the assessment of distal calf and pedal vessels and for the evaluation of patients with arrhythmias and those with impaired cardiac function.
American Journal of Roentgenology 12/2010; 195(6):1444-8. · 2.78 Impact Factor
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ABSTRACT: Sinus venosus atrial septal defect (SV-ASD) can be a challenging diagnostic problem. It can present with non-specific signs and symptoms and, on imaging, can mimic other causes of right heart dilatation. Transthoracic echocardiography using standard scan planes may be limited, due to the defect and any associated anomalous pulmonary venous drainage lying outside the confines of the fossa ovalis. At our institution, we use cardiovascular magnetic resonance imaging (CMRI) as a problem-solving tool in these patients. In this article, we discuss the utility of CMRI in establishing the diagnosis by presenting our recent experience and illustrating it with sample cases. We wish to highlight the problems relating to making a diagnosis of SV-ASD in adult patients, and how CMRI has contributed to overcoming these in our practice.
Heart Lung & Circulation 10/2010; 19(10):615-9. · 1.20 Impact Factor
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Edward T D Hoey
Postgraduate medical journal 09/2010; 86(1019):513-4. · 1.38 Impact Factor
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ABSTRACT: OBJECTIVE: The aim of this article is to present the role of cardiovascular MRI in the assessment of sinus of Valsalva aneurysms. An imaging protocol is described, along with a systematic approach to interpret MR findings and a synopsis of key findings. CONCLUSION: Radiologists should have a systematic approach to the assessment and evaluation of sinus of Valsalva aneurysms to facilitate optimal patient management.
American Journal of Roentgenology 06/2010; 194(6):W495-504. · 2.78 Impact Factor
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ABSTRACT: Transthoracic echocardiography is an established means of diagnosing a pericardial effusion and has become the reference guidance modality for drainage of symptomatic collections. However, echocardiographic drainage is not feasible in all patients for a variety of technical and patient-related factors. Computed tomography (CT)-directed pericardiocentesis using a standard Seldinger technique is an alternative means of draining pericardial effusions and overcomes many of the limitations associated with echocardiography. We present a case in which a CT-guided approach was used to successfully drain a malignant pericardial effusion in the emergent setting. Clinicians should be aware of the potential role of CT in this setting.
The American journal of emergency medicine 03/2010; 28(3):388.e1-3. · 1.54 Impact Factor
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ABSTRACT: Cardiac CT involves acquisition of high-quality ECG-gated dynamic images of the heart. ECG gating allows exquisite delineation of the coronary arteries, which are subjected to respiratory and cardiac motion. Cardiac CT has an established role in the assessment of coronary artery disease in selected patient groups and permits detailed assessment of cardiac and great vessel anatomy. The technique can also be used for a number of non-coronary applications including assessment of the pericardium, cardiac tumours and pulmonary veins. In this article, these applications are reviewed and the salient imaging findings across a range of structural cardiac disease illustrated.
Postgraduate medical journal 03/2010; 86(1013):165-73. · 1.38 Impact Factor
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ABSTRACT: We present a case of complete left pericardial defect which was evaluated with retrospectively gated dual source CT. Imaging findings included right heart chamber dilatation, extreme levoposition and excessive cardiac mobility which was demonstrated by repeat imaging in the left lateral decubitus position. Cardiac CT is an excellent means of evaluating pericardial disease owing to its high spatial resolution. Decubitus imaging helps confidently distinguish partial from complete forms of pericardial defect.
Journal of cardiovascular computed tomography 09/2009; 3(6):417-9.
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ABSTRACT: Many congenital lesions of the thorax are detected for the first time in adulthood when they can simulate a wide range of pathologies, including infection and neoplasia. They can be broadly classified into tracheobronchial, parenchymal, vascular, and combined parenchymal/vascular abnormalities. An awareness of their typical imaging features enables a confident diagnosis and helps direct appropriate patient management.
Canadian Association of Radiologists Journal 08/2009; 60(4):172-81. · 0.69 Impact Factor
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American Journal of Roentgenology 07/2009; 192(6):W341-2; author reply W343. · 2.78 Impact Factor
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ABSTRACT: We present a case of inflammatory myofibroblastic tumor that was evaluated with retrospectively gated dual-source cardiac CT. Imaging features included a broad-based attachment, lobulated contour, and patchy areas of contrast medium enhancement that persisted on delayed imaging. Inflammatory myofibroblastic tumor is an extremely rare slow-growing but locally invasive neoplasm. Cardiac CT has an emerging role in the evaluation of cardiac masses, permitting detailed assessment of lesion extent and relationships. Delayed-enhancement imaging can help with tissue characterization.
Journal of cardiovascular computed tomography 03/2009; 3(2):114-6.
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ABSTRACT: Thoracic computed tomography (CT) is a commonly requested radiological investigation. Anaesthetists should have an understanding of how CT is performed, be aware of appropriate clinical indications and have an approach to interpretation. In this article, we provide an overview of CT technique, highlight relevant cross-sectional thoracic anatomy and provide examples of clinically important pathology. A CT scanner uses X-rays to generate cross-sectional slices through the body. Images are displayed on a monitor screen and interpreted using different ‘windows’ to enhance contrast between structures of similar attenuation. There are many indications for thoracic CT, including staging of lung cancer, investigation of interstitial lung disease and assessment of chest trauma. The scan protocol is tailored according to the clinical question and may involve administration of iodinated intravenous contrast agent.
Anaesthesia & Intensive Care Medicine.
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ABSTRACT: We present a case of complete left pericardial defect which was evaluated with retrospectively gated dual source CT. Imaging findings included right heart chamber dilatation, extreme levoposition and excessive cardiac mobility which was demonstrated by repeat imaging in the left lateral decubitus position. Cardiac CT is an excellent means of evaluating pericardial disease owing to its high spatial resolution. Decubitus imaging helps confidently distinguish partial from complete forms of pericardial defect.
Journal of Cardiovascular Computed Tomography.
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ABSTRACT: Echocardiography is the first-line imaging modality for assessment of structural heart disease but magnetic resonance imaging and multi-detector computed tomography are being increasingly used for cardiac morphologic assessment. Aneurysms and diverticulae of the cardiac chambers and related structures represent a diverse group of conditions with varying etiologies and clinical manifestations. This article reviews the magnetic resonance imaging and multi-detector computed tomography features of these lesions with consideration of the emerging role that cross-sectional imaging has to play in their evaluation. Radiologists should be familiar with the salient imaging appearances of these conditions to facilitate optimal patient management.
Current problems in diagnostic radiology 40(2):72-84.
