Faculty Bibliography

PURPOSE: The objective of this study is to evaluate the effectiveness of nonelectrocardiographic gated multidetector computed tomography (MDCT) performed for the purpose of assessment of pulmonary embolus in the evaluation of myocardial infarction (MI). METHODS: We retrospectively evaluated 147 consecutive patients who had a computed tomography angiogram for pulmonary embolus on a 16-detector MDCT. Of this cohort, we determined 11 patients to have acute MIs based on electrocardiogram, positive troponin levels, and clinical findings and history. Four additional patients were found to have chronic MI based on history. The MDCT data were evaluated by an attending Radiologist, blinded to the clinical data, for quantitative and qualitative attenuations. Each MI was assigned a region of the heart based on its anatomical sections. RESULTS: We were able to detect 10 of 15 MIs, resulting in an overall sensitivity and specificity of 66.6% and 91.4%, respectively. The overall accuracy was 76.7%. If non-Q wave MIs are excluded from the data set, the sensitivity increased to 76.9%. Quantitative analysis of each region of the heart showed that there was a statistically significant difference (P < 0.01) between the infracting regions of the heart (69 +/- 3.3 SEM) and those with normal perfusion (93.3 +/- 1.0 SEM). CONCLUSIONS: While this method did prove to be effective at determining patients who had an MI, the low sensitivity and inability to differentiate chronic from acute myocardial infarction suggest that this technique is very limited in clinical practice.

We present 2 patients with chronic lymphocytic leukemia infiltration of the lung resulting in centrilobular nodularity on computed tomography. We present the x-ray and computed tomography patterns with pathological findings in these cases.

This case demonstrates hypermetabolic activity in a pulmonary round infarct secondary to dirofilariasis. This case further illustrates that pulmonary dirofilariasis, like other infectious causes of pulmonary nodules, can be PET positive.

Congestive heart failure may be caused by late left ventricular (LV) dilation following anterior infarction. Early reperfusion prevents transmural necrosis, and makes the infarcted segment akinetic rather than dyskinetic. Surgical ventricular restoration (SVR) reduces LV volume and creates a more elliptical chamber by excluding scar in either akinetic or dyskinetic segments. The international RESTORE group applied SVR in a registry of 1198 post-infarction patients between 1998 and 2003. Early and late outcomes were examined and risk factors identified. Concomitant procedures included coronary artery bypass grafting in 95%, mitral valve repair in 22%, and mitral valve replacement in 1%. Overall 30-day mortality after SVR was 5.3% (8.7% with mitral repair vs. 4.0% without repair, p < .001) Perioperative mechanical support was uncommon (< 9%). Global systolic function improved pos toperatively, as ejection fraction increased from 29.6 +/- 11.0% to 39.5 +/- 12.3% (p < .001) and left ventricular end systolic volume index decreased from 80.4 +/- 51.4 ml/m² to 56.6 +/- 34.3 ml/m² (p < .001). Overall 5-year survival was 68.6 +/- 2.8%, Logistic regression analysis identified EF <= 30%, LVESVI >= 80 ml/m², advanced NYHA functional class, and age >=75 years as risk factors for death. Five-year freedom from hospital readmission for CHF was 78%. Preoperatively, 67% of patients were class III or IV, and postoperatively 85% were class I or II. SVR improves ventricular function and is highly effective therapy in the treatment of ischemic cardiomyopathy with excellent 5-year outcome.

Merkel Cell Carcinoma (MCC) is a rare neuroendocrine tumor of the skin which has a histological appearance similar to small cell carcinoma of the lung. This case presents a patient with cardiac tamponade from a metastatic MCC to the pericardium. To my knowledge metastatic MCC to the pericardium has not been described in the past. This case will focus on the imaging findings and the differential diagnosis of pericardial masses

Early detection of lung nodules is an important clinical indication for obtaining routine CT studies of the thorax. To date, research has focused on the sensitivity of computer-aided diagnosis (CAD) compared with expert chest radiologists typically using data obtained from single detector CT scanners. The present study focuses on the use of CAD as a second reader supplementing four nonexpert "community level" radiologists using state-of-the-art multidetector high resolution data sets. Evaluations of 18 cases with a total of 87 nodules (average 4.8 per case) were subsequently validated by a panel of two expert dedicated chest radiologists. Only 21% of nodules were identified by all four readers; 17% were identified only by CAD. The mean sensitivity of readers before CAD was 49% while following CAD this improved to 72% (p<0.001). When analyzed by individual lobes, the percentage of these in which nodules could be identified increased from 36% prior to CAD to 44% following CAD (p<0.001). These data support the use of CAD as a second reader specifically for nonexpert radiologists in general clinical practice. (C) 2004 CARS and Elsevier B.V. All rights reserved

BACKGROUND: Compared with 5 days of dosing, a 3 day dosing regimen of azithromycin for treatment of acute otitis media (AOM) may improve compliance, will simplify therapy for the caregiver and, by giving the same total dose as the 5 day regimen, provide more drug when the bacterial burden is highest. METHODS: Children of 6 months-12 years were enrolled if they had had symptoms and signs of AOM for <4 weeks and tympanic membrane effusion by acoustic reflectometry. Eligible children were randomized to azithromycin 10 mg/kg/day x 3 days or co-amoxiclav 45 mg/kg/day x 10 days. The primary endpoint was clinical response at day 28. RESULTS: One hundred and eighty-eight children (mean age 3.5 years) were randomized to azithromycin and 185 to co-amoxiclav. At day 10, the clinical success rate was 153/185 (83%) in children treated with azithromycin and 159/181 (88%) in children treated with co-amoxiclav. At day 28, 134/182 (74%) of the children were cured on azithromycin compared with 124/180 (69%) on co-amoxiclav. Also at day 28, signs of AOM, such as abnormal reflectometry (45% versus 59%; P = 0.017), bulging of the eardrum (10% versus 16%; P = 0.059) and loss of tympanic membrane landmarks (11% versus 22%; P = 0.010) were seen less frequently in azithromycin- than co-amoxiclav-treated children, respectively. Adverse events related to therapy were seen in 11% of azithromycin patients compared with 20% on co-amoxiclav (P = 0.014). CONCLUSIONS: Azithromycin given over 3 days is as effective as co-amoxiclav for treatment of AOM, may result in more complete resolution of tympanic membrane disease, and is better tolerated.