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Wan Fiona Fong-ying,Yeung Catherine Ming-mun,Yam Pak-ki,Ng Pan Pan,Chow Boris Chun Kei,Chiang Jeanie Betsy,Lee Jonan Chun-yin,Cheung Kenneth Kai-yat,Ng Ming-yen 아시아심장혈관영상의학회 2022 Cardiovascular Imaging Asia Vol.6 No.3
Objective:Splenic switch-off (SSO) sign has been utilized as a surrogate marker of adequate stress but can only be assessed after first-pass perfusion imaging. A study previously reported that drop in T1spleen ≥30 ms during adenosine infusion predicts presence of SSO, but this finding has not been externally validated. This study aimed to prospectively validate whether drop in T1spleen ≥30 ms is a reliable marker of SSO and hence adequate stress, and to assess reproducibility of T1spleen measurements. Materials and Methods: Data of fifty consecutive patients undergoing stress cardiac magnetic resonance were prospectively collected. Native T1-maps were acquired at rest and at 2.5 min after adenosine infusion in short axis slices, followed by perfusion images at 3 min. To measure T1spleen pre- and post-adenosine infusion, regions of interest were manually placed to include most splenic tissue. Adenosine stress adequacy was evaluated by visual SSO assessment and semi-quantitative splenic perfusion analysis. Results:A significant association was found between a drop in T1spleen of ≥30 ms and SSO response (p<0.001). There was excellent correlation between SSO response and semiquantitative perfusion change in spleen (rho=0.847, p<0.001). Inter-observer and intra-observer agreement for measurement of ΔT1spleen values were excellent, with intra-class correlation coefficients of 0.987 and 0.995, respectively. By receiver-operating characteristic analysis, the optimal cut-off value of ΔT1spleen for predicting presence of SSO was -28 ms, with area under the curve=0.76 (p=0.002). Conclusion:Splenic T1-mapping is accurate and reproducible for predicting SSO, potentially allowing optimization of adenosine dosage for adequate stress.
Cardiac Angiosarcoma Heralded by Recurrent Hemorrhagic Pericardial Effusions–Utility of MRI and CT
Fiona Fong-ying Wan,Jonan Chun-yin Lee,Jeanie Betsy Chiang,Kim-hung Tsang,Cheuk-bong Ho,Eric Chi-yuen Wong 아시아심장혈관영상의학회 2020 Cardiovascular Imaging Asia Vol.4 No.1
Cardiac angiosarcoma is a rare primary cardiac malignancy that should be considered in patients with recurrent pericardial effusions, especially those with spontaneous hemorrhagic pericardial effusion. A 34-year-old man presented for evaluation of pericardial effusion. Initial imaging and pericardial histopathological workup failed to provide a definitive diagnosis. Serum parvovirus B19 PCR test was positive and he was treated for viral pericarditis. In view of his recurrent hemorrhagic pericardial effusions and persistent right atrial thrombus, MRI was performed and revealed findings suggestive of cardiac angiosarcoma with lung metastases. The diagnosis was confirmed histologically. The patient’s condition progressed rapidly with massive hemothorax, and although he received systemic therapy for disease control, he succumbed to the disease five months after diagnosis confirmation.