Biomedical subjects

I Ikushima

Publications and source records attributed to I Ikushima.

At least 19 recordsLinked to original sources

PubMed2006

Superselective arterial infusion chemotherapy for squamous cell carcinomas of the oral cavity: histopathologic effects on metastatic neck lymph nodes.

We have performed superselective intra-arterial infusion chemotherapy (SIC) on carcinomas of the oral cavity according to a protocol in which the distribution of the drug was evaluated by the use of a combined CT and angiography system, and the chemotherapy was combined with medium-dose conformal radiation therapy (CRT). The purpose of this study was to evaluate the pathological effect of this treatment on the metastatic neck lymph nodes (LNs). Twenty consecutive patients who had metastatic neck LNs from squamous cell carcinomas of the mouth and who underwent both SIC and CRT were included in this study, in which a total of 22 LNs were evaluated. A microcatheter was placed in the appropriate feeding artery of the tumor, such as the internal maxillary artery, facial artery, lingual artery and external carotid artery (ECA), and cisplatin (50 mg/body) was infused twice through a microcatheter. The CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Intra-arterial infusion to the LNs was divided into two groups: superselective infusion (mainly to the submandibular LNs via the facial artery, n = 10) and nonsuperselective infusion via the ECA (n = 12). The distribution of cisplatin into the LNs was confirmed by slow-infusion CT. Histopathologic effects on the LNs were evaluated on the specimens obtained during the operation and classified into five grades (0: no or minimal response: I: disappearance of less than three quarters of the tumor cells: II: disappearance of more than three quarters of the tumor cells: III: disappearance of viable tumor cells with a small amount of residual nonviable tumor cells: IV: complete disappearance of all viable and nonviable tumor cells). Grade 0 or 1 was defined as poor response and Grade II or more as good response. Twenty-three LNs from nine patients without CRT and SIC were served as control. In the superselective infusion group, all 10 LNs showed good response (response rate, 100%: grade II = 4, grade III = 3, grade IV = 3). In the non-superselective group, however, 6 of 12 LNs showed poor response (response rate, 50%: grade 0 = 2, grade I = 4, grade II = 2, grade III = 2, grade IV = 2). All 23 control LNs with no treatment showed grade 0 response. Superselective infusion seems necessary to obtain good histopathologic effects on the metastatic LNs. SIC combined with CRT can be applied to the metastatic LNs.

Adult↗

PubMed2006

Evaluation of drainage patterns of the major anastomotic veins on the lateral surface of the cerebrum using three-dimensional contrast-enhanced MP-RAGE sequence.

BACKGROUND AND PURPOSE: Three-dimensional (3D) contrast-enhanced magnetization-prepared rapid gradient-echo (MP-RAGE) sequence has been reported useful for evaluation of the intracranial venous structures. The purpose of this study is to assess the patterns of the major anastomotic veins on the lateral surface of the cerebrum using MP-RAGE sequence. METHODS: MP-RAGE images in consecutive 100 patients (200 sides) were reviewed by two neuroradiologists in consensus to evaluate drainage patterns of the superficial middle cerebral vein (SMCV), the vein of Labbe, and the Trolard vein. RESULTS: MP-RAGE images clearly depicted the major anastomotic veins and their draining vessel. The dominant vein was the Trolard vein in 12%, the vein of Labbe in 36%, SMCV in 38%, and all three veins in 14%. The vein of Labbe was entered the transverse sinus in 80% and superior petrosal sinus in 4%. Undeveloped type of the vein of Labbe was seen in 16%. The SMCVs were entered the sphenoparietal sinus in 57%, the cavernous sinus in 19%, and the emissary vein in 5%. Basal type of the SMCVs was seen in 3% and undeveloped type in 16%. It was difficult to differentiate the Trolard vein from other cortical veins, if it was not dominant. In the most cases with the dominant Trolard vein, it located at the level of the post central vein. CONCLUSION: With MP-RAGE sequence, it is easy to identify the variation of the major anastomotic veins. Such information may be helpful to reduce the risk of damage on these important veins at surgery.

Adolescent↗

PubMed2006

Usefulness of measurement of the temporal stem on magnetic resonance imaging in the diagnosis of frontotemporal dementia.

PURPOSE: To investigate whether measurements of brain structures on routine magnetic resonance (MR) images can be used to distinguish between normal subjects and patients with frontotemporal dementia (FTD) or Alzheimer's disease (AD). MATERIAL AND METHODS: MRI studies were performed on 30 patients with dementia (FTD, n = 15; AD, n = 15) and 15 age-matched controls. Width measurements, obtained at the corpus callosum, the cingulate gyri, the hippocampi, and the temporal stem of the anterior temporal lobes, were compared among FTD and AD patients and control subjects on oblique-coronal T2-weighted images. RESULTS: The width of the temporal stem was significantly narrower in FTD than in AD patients and control subjects (6.3 +/- 1.3 mm, 7.8 +/- 1.1 mm, and 8.2 +/- 0.9 mm, respectively) (P < 0.05), although there was some overlapping between AD and FTD patients. All patients whose temporal stem width was < 6 mm had FTD. While the width of the corpus callosum, cingulate gyri, and hippocampi was significantly narrower in patients with AD and FTD than in the controls, there was no significant difference between the AD and FTD patients. CONCLUSION: The width of the temporal stem was significantly narrower in patients with FTD than in those with AD and controls. The described measurements can easily be obtained and may be useful for the diagnosis of FTD.

Aged↗

PubMed2006

Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity.

BACKGROUND AND PURPOSE: On diffusion-weighted imaging (DWI), metastatic tumors of the brain may exhibit different signal intensities (SI) depending on their histology and cellularity. The purpose of our study was to verify the hypotheses (1) that SI on DWI predict the histology of metastases and (2) that apparent diffusion coefficient (ADC) values reflect tumor cellularity. MATERIALS AND METHODS: We assessed conventional MR images, DWI, and ADC maps of 26 metastatic brain lesions from 26 patients, 13 of whom underwent surgery after the MR examination. Two radiologists performed qualitative assessment by consensus of the SI on DWI in areas corresponding to their enhancing portions. We measured the contrast-to-noise ratio (CNR) on T2-weighted images and normalized ADC (nADC) values, and compared them with tumor cellularity. RESULTS: The mean SI on DWI and the CNR on T2-weighted images were significantly lower in well differentiated than in poorly differentiated adenocarcinomas and lesions other than adenocarcinoma. The mean nADC value was significantly higher in well differentiated than poorly differentiated adenocarcinomas and lesions other than adenocarcinoma. All 3 small-cell carcinomas and 1 large-cell neuroendocrine carcinoma exhibited high SI on DWI. The nADC value showed a significant inverse correlation with tumor cellularity. There was no significant correlation between the CNR and tumor cellularity. CONCLUSION: The SI on DWI may predict the histology of metastases; well differentiated adenocarcinomas tended to be hypointense, and small- and large-cell neuroendocrine carcinomas showed hyperintensity. Their ADC values reflect tumor cellularity.

Adenocarcinoma↗

PubMed2002

MRI of intracranial germ-cell tumours.

Our aim was to review the MRI appearances of primary intracranial germ-cell tumours (GCT). We reviewed the MRI studies of 32 patients: 19 with germinomas, five with teratomas, one with an embryonal carcinoma, five with mixed and two with malignant nongerminomatous GCT. Eleven were in the pineal region, 12 suprasellar, five in the both sites, two in the basal ganglia and two in the corpus callosum. Contrast-enhanced images were available for 27 patients. The solid parts of GCT were nearly isointense with grey matter on both T1- and T2-weighted images. In seven patients with nongerminomatous GCT high-signal components were found on T1-weighted images, representing haemorrhage, high-protein fluid or fat. Cystic components were detected in 17 of 27 patients; eight germinomas and all nine nongerminomatous GCT had cysts. The solid components of germinomas enhanced homogeneously in eight cases and heterogeneously in 10, while all nongerminomatous GCT showed heterogeneous enhancement. MRI features tumours can facilitate correct diagnosis of GCT, including histological subtypes.

Adolescent↗

PubMed2000

Dynamic MR imaging of neurohypophyseal germ cell tumors for differential diagnosis of infundibular diseases.

PURPOSE: To investigate the MR dynamic patterns of neurohypophyseal germ cell tumors (GCTs) for differential diagnosis of infundibular diseases affecting young people. MATERIAL AND METHODS: Eleven patients with neurohypophyseal GCTs underwent dynamic MR studies with Tl-weighted spin-echo (SE) or turbo SE techniques. Other infundibular lesions, including adenohypophysitis (n=3), Langerhans' cell histiocytosis (LCH, n=2), and 1 hemangioblastoma from von Hippel-Lindau disease, were also evaluated. Serial images were obtained every 15 s (turbo SE) or 30 s (SE technique) for 240 s after rapid injection of contrast medium. The dynamic patterns were analyzed quantitatively with the contrast medium enhancement ratio. RESULTS: On dynamic MR images, GCTs typically showed a gradual enhancement increase with a peak between 105 s and 180 s, while two showed a relatively rapid increase. LCH and hemangioblastoma showed a dynamic pattern similar to GCTs, while adenohypophysitis demonstrated a sharp rise and a steeper wash-out with an obvious peak before 90 s. CONCLUSION: Typical dynamic pattern of GCTs was the gradual enhancement increase without wash-out. Dynamic MR imaging can distinguish GCTs from adenohypophysitis, but is not useful for differentiation from LCH.

Adolescent↗

PubMed2000

Evaluation of dural sinus invasion and extension of extra-axial intracranial tumors. The advantages of a high-resolution postcontrast 3-D gradient-echo technique.

OBJECTIVE: To assess the usefulness of a postcontrast 3-D Fourier transform (3DFT) gradient-echo (GRE) technique in dural sinus invasion and extension of extraaxial intracranial tumors in comparison with a conventional spin-echo (SE) technique. MATERIAL AND METHODS: Fourteen consecutive patients with 15 extra-axial tumors in contiguity with the dural sinus, including 14 meningiomas and 1 adenoid cystic carcinoma, underwent postcontrast T1-weighted SE and GRE MR studies. Detectability of dural sinus invasion and extension was evaluated using two sequences by two neuroradiologists in a blinded manner and compared with surgical results. Quantitative analysis was also performed to calculate the contrast-to-noise ratio (CNR) between lesion and dural sinus on SE and GRE images. The data were analyzed statistically using a matched paired t-test. RESULTS: In the qualitative evaluation, the detectability of dural sinus invasion in 3DFT-GRE images was superior to that using SE images. The mean CNR for all lesions was 3.86 on SE images and 5.63 on 3DFT-GRE images (p = 0.03). CONCLUSION: For evaluation of dural sinus invasion and the extension of extra-axial tumors, postcontrast 3DFT-GRE MR images were superior to conventional SE images.

Adult↗

PubMed2000

Posttherapeutic intraaxial brain tumor: the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating tumor recurrence from nonneoplastic contrast-enhancing tissue.

BACKGROUND AND PURPOSE: Differentiation of tumor recurrence from treatment-related changes may be difficult with conventional MR imaging when newly enhancing lesions appear. Our aim was to determine the value of perfusion-sensitive contrast-enhanced MR imaging for differentiating recurrent neoplasm from nonneoplastic contrast-enhancing tissue. METHODS: Twenty patients in whom new enhancing lesions developed within irradiated regions were examined prospectively with perfusion-sensitive contrast-enhanced MR imaging. Twelve of them also underwent thallous chloride Tl 201 single-photon emission tomography (201Tl-SPECT). Normalized relative cerebral blood volume (rCBV) ratios and thallium indexes were evaluated to determine whether the new enhancing lesions were recurrent or not. Five instances of tumor recurrence and one of radiation necrosis were verified histologically; in the others, tumor recurrence was distinguished by lesions that progressively increased in size on serial MR examinations over at least 5 months, and nonneoplastic contrast-enhancing tissue was distinguished by lesions that disappeared or decreased in size on serial MR studies over at least 9 months. RESULTS: When normalized rCBV ratios were higher than 2.6 or lower than 0.6, enhancing lesions were either recurrent (n = 5) or nonneoplastic contrast-enhancing tissue (n = 3), respectively. All nonneoplastic contrast-enhancing tissue had a low thallium index, whereas three of four recurrent lesions had a high index. CONCLUSION: An enhancing lesion with a normalized rCBV ratio higher than 2.6 or lower than 0.6 may suggest tumor recurrence or nonneoplastic contrast-enhancing tissue, respectively. In these cases, further examination with 201Tl-SPECT may not be necessary. However, when the normalized rCBV ratio is between 0.6 and 2.6, 201Tl-SPECT may be useful in making the differentiation.

Adolescent↗

PubMed1999

Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas.

The purpose of this study was to evaluate the utility of diffusion-weighted magnetic resonance imaging (MRI) with echo-planar imaging (EPI) technique in depicting the tumor cellularity and grading of gliomas. Twenty consecutive patients (13 men and 7 women, ranging in age from 13 to 69 years) with histologically proven gliomas were examined using a 1.5 T superconducting imager. Tumor cellularity, analyzed with National Institutes of Health Image 1.60 software on a Macintosh computer, was compared with the minimum apparent diffusion coefficient (ADC) and the signal intensity on the T2-weighted images. The relationship of the minimum ADC to the tumor grade was also evaluated. Tumor cellularity correlated well with the minimum ADC value of the gliomas (P = 0.007), but not with the signal intensity on the T2-weighted images. The minimum ADC of the high-grade gliomas was significantly higher than that of the low-grade gliomas. Diffusion-weighted MRI with EPI is a useful technique for assessing the tumor cellularity and grading of gliomas. This information is not obtained with conventional MRI and is useful for the diagnosis and characterization of gliomas.

Adolescent↗

PubMed1999

Brain lesions: when should fluid-attenuated inversion-recovery sequences be used in MR evaluation?

PURPOSE: To compare qualitatively and quantitatively the contrast of brain lesions detected with fluid-attenuated inversion-recovery (FLAIR) and intermediate-weighted sequences at magnetic resonance (MR) imaging. MATERIALS AND METHODS: In this prospective study, 47 patients suspected of having a brain lesion underwent MR imaging with FLAIR, intermediate-weighted, and T2-weighted sequences. Qualitative assessment was performed of lesion conspicuity, detection, overall image artifact, and additional clinical information. Contrast and contrast-to-noise ratio (CNR) were calculated between lesions and the normal brain or cerebrospinal fluid (CSF). RESULTS: FLAIR images were equal to intermediate-weighted images for overall lesion conspicuity and detection but were associated more often with image artifacts. Lesion-to-background contrast was significantly higher on FLAIR than on intermediate-weighted images. FLAIR images failed to demonstrate multiple sclerosis (MS) plaques located in the basal ganglia and brain stem. CONCLUSION: Although FLAIR images provided additional information in some cases, they did not have distinct advantages over intermediate-weighted images. When cases of MS are evaluated, intermediate-weighted images are preferable to FLAIR images. Except in cases of MS, either FLAIR or intermediate-weighted sequences should be added to T2-weighted sequences at MR imaging.

Adolescent↗

PubMed1999

MRI of arachnoid granulations within the dural sinuses using a FLAIR pulse sequence.

The purpose of the study was to assess the signal intensities of arachnoid granulations within the dural sinuses using the FLAIR sequence for differentiation of space-occupying lesions in and adjacent to the dural sinuses. We retrospectively reviewed MR images of the brain of 1118 consecutive subjects, ranging in age from 0 to 93 years (mean 57.2 years). Nodules within the dural sinuses with signal intensities similar to that of cerebrospinal fluid (CSF) on both T1 and T2 weighted images were defined as arachnoid granulations. The location, signal intensity on T1 weighted spin echo (SE), T2 weighted fast SE and FLAIR images, the impression on the inner table of the skull, and the size of the lesion were assessed. 112 subjects (10.0%), age range 4-89 years old (mean 58.9 years), were found to have 134 arachnoid granulations. The commonest location was the transverse sinus, with 115 granulations (85.8%). The prevalence of the granulations showed a peak in the sixth decade of age. All granulations were isointense relative to CSF on T2 weighted images and almost all lesions were isointense relative to CSF on T1 weighted images. On FLAIR images, 90.3% of the granulations were isointense relative to CSF and the other 9.7% granulations were slightly hyperintense compared with the CSF. 21 (15.7%) subjects showed impressions on the inner table; one case involved the outer table. In conclusion, arachnoid granulations were isointense or slightly hyperintense relative to CSF on FLAIR. FLAIR images are helpful in differentiating arachnoid granulations from other dural sinus lesions or skull lesions which have an intensity similar to that of CSF on T1 weighted and T2 weighted images.

Adolescent↗

PubMed1999

MR imaging of Tornwaldt's cysts.

OBJECTIVE: The purpose of this study was to assess the characteristics of Tornwaldt's cysts as revealed by routine MR studies. MATERIALS AND METHODS: We retrospectively reviewed MR images of the brain in 1208 consecutive subjects who ranged in age from 3 weeks to 93 years (mean, 57.1 years). The signal intensity, shape, and size of Tornwaldt's cysts were assessed. Patients with Tornwaldt's cysts were then questioned about the presence of persistent nasal discharge, occipital headaches, and halitosis and an unpleasant taste in the mouth and about a history of adenoidectomy. RESULTS: Tornwaldt's cysts were found in 23 patients (1.9%) who ranged in age from 39 to 78 years (mean, 57.3 years). Of the 23 Tornwaldt's cysts, all were isointense to CSF on T2-weighted images and hyperintense to gray matter on the fluid-attenuated inversion-recovery images. The cysts showed high signal intensity compared with muscle on T1-weighted images. Nineteen cysts were round and four were oval. The mean size of the lesions was 6.0 mm in the major axis and 5.5 mm in the minor axis. Two patients with Tornwaldt's cysts had persistent nasal discharge and occipital headaches, and another patient had occipital headaches alone. None of the patients had undergone an adenoidectomy. CONCLUSION: Lesions consistent with Tornwaldt's cysts were found in 1.9% of the routine MR studies of the brain. The cysts had high signal intensity on T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery images.

Adolescent↗

PubMed1999

[One-hour protocol stress myocardial scintigraphy: prospective study of diagnostic accuracy for the detection of coronary artery stenosis].

A one-hour protocol for stress myocardial scintigraphy using technetium-99m-tetrofosmin (Tc-tetrofosmin) was compared with coronary arteriography for the detection of coronary artery stenosis in 90 consecutive patients without prior myocardial infarction, revascularization procedure or vasospastic angina. Tc-tetrofosmin stress myocardial scintigraphy acquired a rest image 20 min after intravenous administration of Tc-tetrofosmin (185 MBq, 1/5 vial) using a three-head gamma camera collecting 20-sec views over 360 degrees. The stress test using bicycle ergometer was performed and administration of Tc-tetrofosmin (740 MBq, 4/5 vial) was repeated at the peak stress point. The stress image was acquired 15 min after the second injection with 5-sec views over 360 degrees. Coronary arteriography revealed the presence of significant coronary artery stenosis (> 75%) in 56 vessels of 45 patients, including 35 patients with single-vessel disease, 5 with two-vessel disease, 2 with three-vessel disease, and 3 with left main trunk disease. The overall sensitivity and specificity for the detection of coronary artery disease by visual analysis were 91.1% and 77.8%, respectively, and by quantitative analyses (using bull's-eye method) were 95.6% and 91.1%, respectively. The individual stenotic vessel sensitivities in the right coronary artery, left anterior descending artery, and left circumflex artery were 84.6%, 90.9%, and 78.6%, respectively. The specificities were 97.3%, 95.9%, and 100.0%, respectively. These results suggest that stress myocardial scintigraphy using the present new protocol is a promising approach for the detection of coronary artery stenosis.

Angina Pectoris↗

PubMed1999

Detection of intracranial hemorrhage with susceptibility-weighted MR sequences.

BACKGROUND AND PURPOSE: Detection of hemorrhage is important in the diagnosis and management of a variety of intracranial diseases. We evaluated the sensitivity of the following sequences for depicting chronic hemorrhagic foci associated with susceptibility dephasing: gradient-recalled echo (GRE) imaging, GRE-type single-shot echo-planar imaging (GRE-EPI), spin-echo-type single-shot echo-planar imaging (SE-EPI), turbo spin-echo (TSE) imaging, half-Fourier single-shot turbo spin-echo (HASTE) imaging, and segmented HASTE (s-HASTE) imaging. To our knowledge, no previous comparison has been made with these techniques in the same patient. METHODS: Fifty patients with suspected chronic hemorrhage were examined prospectively with the above six sequences. Contrast-to-noise ratio (CNR), sensitivity to detection of lesions, conspicuity of internal architecture, and sensitivity to small hemorrhagic foci were evaluated. RESULTS: Hemorrhagic foci were found in 35 patients. The CNR of the GRE, GRE-EPI, SE-EPI, TSE, s-HASTE, and HASTE sequences was 30.9, 23.7, 3.6, 6.1, -29.3, and -13.1, respectively; the number of small hemorrhagic foci detected was 85, 96, 44, 22, two, and one, respectively, for the supratentorial white matter; 70, 40, 19, four, zero, and zero, respectively, for the supratentorial cortical/subcortical region; and 73, 50, 26, 37, zero, and zero, respectively, for the infratentorial/skull-base region. CONCLUSION: The GRE sequence was best for detecting susceptibility dephasing associated with chronic intracranial hemorrhage. GRE-EPI, while comparable to GRE in the supratentorial compartment, was reduced in its sensitivity near the skull base, and may be used as an alternative to GRE in uncooperative, unsedated, pediatric, or claustrophobic patients. SE-EPI should not be used in screening for intracranial hemorrhage.

Adolescent↗

PubMed1998

Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces.

We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure.

Adolescent↗

PubMed1998

Pulsatile cycle-specific data acquisition in carotid MR angiography with segmented FLASH sequence: experimental and clinical investigation.

RATIONALE AND OBJECTIVES: The authors evaluated the usefulness of diastolic data acquisition in magnetic resonance (MR) angiography of the carotid artery. MATERIALS AND METHODS: MR angiographic images of phantom models of 30%, 40%, and 50% stenosis were obtained at different pulsatile cycles by using variable delay times from the electrocardiogram triggering with segmented fast low-angle shot sequences (14/7.3 [repetition time msec/echo time msec]) with k-space segmentation. The degree of stenosis was measured on the MR angiographic images by three observers. Poststenotic signal intensity loss was analyzed by measuring the signal intensity on the axial image acquired 10 mm distal to the stenotic portion of the 50% stenosis phantom at variable delay time from triggering. Six patients with stenosis of the internal carotid artery also underwent conventional and MR angiography. The degree of stenosis depicted on diastolic- and systolic-phase MR angiographic images was measured by three observers and compared with that shown on the conventional angiographic images. RESULTS: The diastolic-phase images more accurately depicted the degree of stenosis than did the systolic-phase images in the phantom and all six patients, although the degree of stenosis tended to be overestimated on both images. The degree of stenosis was most overestimated with triggering that occurred at the time of peak flow velocity. In the phantom with 50% stenosis, the signal intensity 10 mm distal to the stenotic portion was decreased in the systolic phase. CONCLUSION: Diastolic data acquisition is a useful method of reducing intra- and poststenotic signal intensity loss in the carotid artery.

Aged↗

PubMed1998

Magnetic resonance imaging of Bland-White-Garland syndrome--a case of anomalous origin of the left coronary artery from the pulmonary trunk in a 22-year-old woman.

Selective right coronary angiography in a 22-year-old woman demonstrated an enormous right coronary artery, with the contrast medium opacifying to the left coronary artery through a well-developed collateral circulation and draining into the pulmonary artery. The diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk [also known as Bland-White-Garland (BWG) syndrome] was thus established. Magnetic resonance imaging (MRI) showed a dilated right coronary artery arising from the aorta, the left coronary artery from the pulmonary trunk but not from the aorta, and well-developed channels in the interventricular septum. MRI could be a useful tool for diagnosing anomalous origin of the left coronary artery from the pulmonary trunk.

Coronary Vessel Anomalies↗

PubMed1998

Effect of pacing rate in pacing therapy in hypertrophic obstructive cardiomyopathy.

The effects of dual-chamber pacing therapy in patients with hypertrophic obstructive cardiomyopathy (HOCM) have been reported in short- and long-term studies. Almost all of these studies have reported that the key factor in pacing therapy is the setting of the atrioventricular (AV) interval. However, studies focusing on the effects of pacing rate on the hemodynamic state are rare. In this study, cardiac catheterization was performed in 2 patients during temporary pacing at various rates and AV intervals. When the pacing rate was increased slightly (to 70-90/min), AV sequential pacing decreased peak subaortic pressure gradient and increased systolic aortic pressure without increase in pulmonary capillary wedge pressure, left ventricular end-diastolic pressure, and the time constant of isovolumetric relaxation. In another case, of a patient who became refractory to AV sequential pacing therapy at an optimum AV interval, pacing at a slightly higher rate relieved syncope. Thus, AV sequential pacing therapy performed at a slightly higher rate than normal in a patient with HOCM may lead to a decreased subaortic pressure gradient and relief of symptoms without noticeable deterioration in cardiac function.

Adult↗