High Tidal Volume, High Positive End Expiratory Pressure and Apneic Breath Hold Strategies (Lung Navigation Ventilation Protocol) With Cone Beam Computed Tomography Bronchoscopic Biopsy of Peripheral Lung Lesions: Results in 100 Patients.

Background: A dedicated anesthesia protocol for bronchoscopic lung biopsy-lung navigation ventilation protocol (LNVP)-specifically designed to mitigate atelectasis and reduce unnecessary respiratory motion, has been recently described. LNVP demonstrated significantly reduced dependent ground glass, sublobar/lobar atelectasis, and atelectasis obscuring target lesions compared with conventional ventilation.

Methods: In this retrospective, single-center study, we examine the impact of LNVP on 100 consecutive patients during peripheral lung lesion biopsy.

A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions.

Background: Compared with the standard cryoprobe, the novel ultrathin 1.1 mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials.

Lung Navigation Ventilation Protocol to Optimize Biopsy of Peripheral Lung Lesions.

Background: Computed tomography-to-body divergence caused by respiratory motion, atelectasis, diaphragmatic motion and other factors is an obstacle to peripheral lung biopsies. We examined a conventional ventilation strategy versus a lung navigation ventilation protocol (LNVP) optimized for intraprocedural 3-dimensional image acquisition and bronchoscopic biopsy of peripheral lung nodules.

Methods: A retrospective, single center study was conducted in consecutive subjects with peripheral lung lesions measuring <30 mm.

Cone beam CT imaging for bronchoscopy: a technical review.

Cone beam computed tomography (CBCT) is a well-established imaging modality with numerous proven applications across multiple clinical disciplines. More recently, CBCT has emerged as an important imaging tool for bronchoscopists, primarily used during transbronchial biopsy of peripheral pulmonary lesions (PPLS). For this application CBCT has proved useful in navigating devices to a target lesion, in confirming device tool-in-lesion, as well as during tissue acquisition.

Association of intracranial arteriovenous malformation embolization with more rapid rate of perfusion in the peri-nidal region on color-coded quantitative digital subtraction angiography.

Background: Hemodynamic alterations post-embolization of intracranial arteriovenous malformations (AVMs) may cause delayed edema/hemorrhage in brain parenchyma adjacent to the lesion.

Objective: To quantify and compare cerebral perfusion changes in the peri-AVM territory pre- and post-embolization using color-coded quantitative digital subtraction angiography (q-DSA).

Methods: Pediatric intracranial AVM embolization procedures performed over a 5 year period were included.

Prospective evaluation of MR overlay on real-time fluoroscopy for percutaneous extremity biopsies of bone lesions visible on MRI but not on CT in children in the interventional radiology suite.

Magnetic resonance imaging (MRI) often provides better visualization of bone marrow abnormalities than computed tomography (CT) or fluoroscopy, but bone biopsies are usually performed using conventional CT or, more recently, C-arm CT guidance. Biopsies of bone lesions solely visible on MRI are often challenging to localize and require the operator to review the MRI on a separate console to correlate with MRI anatomical landmarks during the biopsy. The MR overlay technique facilitates such biopsies in the angiographic suite by allowing the pre-procedural 3-D MRI to be overlaid on intraprocedural 2-D fluoroscopy.

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children.

Background: Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite.

Objective: We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies.

Materials And Methods: Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval.

Real-time three dimensional CT and MRI to guide interventions for congenital heart disease and acquired pulmonary vein stenosis.

To validate the feasibility and spatial accuracy of pre-procedural 3D images to 3D rotational fluoroscopy registration to guide interventional procedures in patients with congenital heart disease and acquired pulmonary vein stenosis. Cardiac interventions in patients with congenital and structural heart disease require complex catheter manipulation. Current technology allows registration of the anatomy obtained from 3D CT and/or MRI to be overlaid onto fluoroscopy.

Early experience with X-ray magnetic resonance fusion for low-flow vascular malformations in the pediatric interventional radiology suite.

This technical innovation describes our experience using an X-ray magnetic resonance fusion (XMRF) software program to overlay 3-D MR images on real-time fluoroscopic images during sclerotherapy procedures for vascular malformations at a large pediatric institution. Five cases have been selected to illustrate the application and various clinical utilities of XMRF during sclerotherapy procedures as well as the technical limitations of this technique. The cases demonstrate how to use XMRF in the interventional suite to derive additional information to improve therapeutic confidence with regards to the extent of lesion filling and to guide clinical management in terms of intraprocedural interventional measures.

PINOT NOIR: pulmonic insufficiency improvement with nitric oxide inhalational response.

Background: Tetralogy of Fallot (TOF) repair and pulmonary valvotomy for pulmonary stenosis (PS) lead to progressive pulmonary insufficiency (PI), right ventricular enlargement and dysfunction. This study assessed whether pulmonary regurgitant fraction measured by cardiovascular magnetic resonance (CMR) could be reduced with inhaled nitric oxide (iNO).

Methods: Patients with at least moderate PI by echocardiography undergoing clinically indicated CMR were prospectively enrolled.

Effect of protocol choice on phase contrast cardiac magnetic resonance flow measurement in the ascending aorta: breath-hold and non-breath-hold.

Flow assessment with phase contrast magnetic resonance imaging (PC-MRI) protocols is an important component of a comprehensive cardiovascular MR (CMR) assessment. Breath-hold (BH) and non-breath-hold (NBH) PC-MRI protocols are widely available for this imaging modality. Because flow in the great vessels is known to vary with the respiratory cycle, we hypothesized that these 2 approaches might yield different results in the clinical assessment of forward and regurgitant flow in the ascending aorta.

Orthogonal CSPAMM (OCSPAMM) MR tagging for imaging ventricular wall motion.

Tagged magnetic resonance imaging (MRI) has the ability to directly and non-invasively alter tissue magnetization and produce tags on the deforming tissue [1], [2]. Since its development, the Spatial Modulation of Magnetization (SPAMM) [2] tagging pulse sequence has been widely available and is the most commonly used technique for producing sinusoidal tag patterns. However, SPAMM suffers from tag fading which occurs in the later phases of the cardiac cycle.

Aortic volume as an indicator of disease progression in patients with untreated infrarenal abdominal aneurysm.

Objective: The maximal diameter of an abdominal aortic aneurysm (AAA) and the change in diameter over time reflect rupture risk and are used for surgical planning. However, evidence has emerged that aneurysm volume may be a better indicator of AAA remodeling. The purpose of this study was to assess the relationship between the volume and maximal diameter of the abdominal aorta in patients with untreated infrarenal AAA.

Utility of free-breathing, whole-heart, three-dimensional magnetic resonance imaging in the assessment of coronary anatomy for congenital heart disease.

The incidence of coronary anomalies is increased in congenital heart disease (CHD). Whole-heart magnetic resonance imaging (MRI) has been proposed as a robust approach to coronary artery imaging without ionizing radiation. The proximal coronary arteries were imaged in 112 CHD patients (63 males) age 17 ± 13 years (range 11 days-68 years) using a navigator-gated, whole-heart, three-dimensional (3D) technique at 1.

Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance.

Aims: We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR).

Methods And Results: We studied 339 patients (24% women, mean age 65 +/- 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium.

Aortic stiffness is increased in hypertrophic cardiomyopathy with myocardial fibrosis: novel insights in vascular function from magnetic resonance imaging.

Objectives: The aim of the study was to determine if patients with hypertrophic cardiomyopathy (HCM), both with and without myocardial fibrosis, have altered aortic stiffness as assessed by magnetic resonance imaging (MRI) pulse wave velocity (PWV) measurements.

Background: Abnormal aortic stiffness implies an unfavorable prognosis and has been established in a variety of aortic diseases and ischemic cardiomyopathy. However, the relationship between aortic stiffness and HCM has not been studied previously.

Cardiac magnetic resonance detection of myocardial scarring in hypertrophic cardiomyopathy: correlation with histopathology and prevalence of ventricular tachycardia.

Objectives: In hypertrophic cardiomyopathy (HCM) patients undergoing surgical myectomy, we sought to determine the association between pre-operative cardiac magnetic resonance (CMR) findings, small intramural coronary arteriole dysplasia (SICAD) on histopathology, and ventricular tachycardia (VT).

Background: Myocardial scarring (fibrosis) and SICAD are frequently observed on histopathology in HCM patients. CMR measures wall thickness and detects scar.

Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study.

Objectives: The objective of the study was to determine whether the extent of left ventricular scar, measured with delayed hyperenhancement cardiac magnetic resonance (DHE-CMR), predicts survival in patients with ischemic cardiomyopathy (ICM) and severely reduced left ventricular ejection fraction (LVEF).

Background: Patients with ICM and reduced LVEF have poor survival. Such patients have a high myocardial scar burden.

Association of myocardial fibrosis, electrocardiography and ventricular tachyarrhythmia in hypertrophic cardiomyopathy: a delayed contrast enhanced MRI study.

Background: Patients with hypertrophic cardiomyopathy (HCM) are predisposed to ventricular tachyarrhythmia (VT); likely due to myocardial fibrosis or disarray. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately detects myocardial fibrosis (scar). We sought to determine the association between septal thickness, myocardial scar and VT.

Influence of coronary artery stenosis severity and coronary collateralization on extent of chronic myocardial scar: insights from quantitative coronary angiography and delayed-enhancement MRI.

Objectives: In patients with chronic ischemic heart disease, the relationship between coronary artery lesion severity and myocardial scarring is unknown.The purpose of this study was to examine the relationship between proximal coronary artery stenosis severity, the amount of coronary collateralization, and myocardial scar extent in the distal distribution of the affected coronary artery based on both quantitative coronary angiography (QCA) and delayed-enhancement magnetic resonance imaging (DE-MRI).

Methods: Thirty-four patients (26 males, 8 females; age range: 35-86 years) with a coronary artery containing a single, proximal stenosis >/=30% by quantitative coronary angiography (QCA) underwent DE-MRI.

Left ventricular torsional mechanics after left ventricular reconstruction surgery for ischemic cardiomyopathy.

Objectives: Surgical left ventricular reconstruction improves symptoms and potentially prognosis in patients with ischemic cardiomyopathy; however, the effects of reconstruction on myocardial mechanics are not well defined. Therefore, we have computed left ventricular rotation and torsion in patients undergoing left ventricular reconstruction to determine its effects on these quantitative measures of myocardial mechanics.

Methods: Magnetic resonance imaging with tissue grid-tagging was performed in 26 patients (19 male/7 female, 62 +/- 11 years) (mean +/- standard deviation) before (23 +/- 29 days) and after (231 +/- 106 days) left ventricular reconstruction, as well as in 7 healthy volunteers (5 male/2 female, 34 +/- 7 years).

Noninvasive quantification of fluid mechanical energy losses in the total cavopulmonary connection with magnetic resonance phase velocity mapping.

A major determinant of the success of surgical vascular modifications, such as the total cavopulmonary connection (TCPC), is the energetic efficiency that is assessed by calculating the mechanical energy loss of blood flow through the new connection. Currently, however, to determine the energy loss, invasive pressure measurements are necessary. Therefore, this study evaluated the feasibility of the viscous dissipation (VD) method, which has the potential to provide the energy loss without the need for invasive pressure measurements.

Effects of surgical ventricular restoration on left ventricular function: dynamic MR imaging.

Purpose: To retrospectively evaluate with dynamic magnetic resonance (MR) imaging the changes in global and regional left ventricular (LV) function after surgical ventricular restoration (SVR) performed in chronic ischemic heart disease patients with large nonaneurysmal or aneurysmal postmyocardial infarction zones.

Materials And Methods: The study was performed with institutional review board approval, and a waiver of individual informed consent was obtained. The study was HIPAA compliant.

Tracking and analysis of cine-delayed enhancement MR.

Cine-DEMR is a new cardiac imaging technique which combines aspects of Cine and Delayed Enhancement MR. Like Cine, it displays the heart beating over time allowing for the detection of motion abnormalities. Like DEMR, non-viable (dead) tissues appear with increased signal intensity (it has been shown that the extent of non-viable tissue in the left ventricle (LV) of the heart is a direct indicator of patient survival rate).