In the evaluation of pericardial disease, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT and MR imaging are particularly useful as sensitive and noninvasive methods for evaluating loculated or hemorrhagic pericardial effusion, constrictive pericarditis, and pericardial masses. Both CT and MR imaging provide excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, constrictive pericarditis and pericardial thickening, pericardial masses, and congenital anomalies such as partial or complete absence of the pericardium. Both modalities provide a larger field of view than does echocardiography, allowing the examination of the entire chest and detection of associated abnormalities in the mediastinum and lungs. Soft-tissue contrast on CT scans and MR images also is superior to that on echocardiograms. Given the many potential applications of these modalities in the evaluation of pericardial diseases, familiarity with the CT and MR imaging features of these diseases is important.

https://pubs.rsna.org/doi/pdf/10.1148/rg.23si035504

CT and MR imaging of pericardial disease.

Multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome: a prospective study of 107 cases and comparison with 1009 cases from the literature.

Objectives To determine normal limits for ascending and descending thoracic aorta diameters in a large population of asymptomatic, low-risk adult subjects. Background Assessment of aortic size is possible from gated noncontrast computed tomography (CT) scans obtained for coronary calcium measurements. However, normal limits for aortic size by these studies have yet to be defined. Methods In 4,039 adult patients undergoing coronary artery calcium (CAC) scanning, systematic measurements of the ascending and descending thoracic aorta diameters were made at the level of the pulmonary artery bifurcation. Multiple linear regression analysis was used to detect risk factors independently associated with ascending and descending thoracic aorta diameter and exclude subjects with these parameters from the final analysis. The final analysis groups for ascending and descending thoracic aorta included 2,952 and 1,931 subjects, respectively. Subjects were then regrouped by gender, age, and body surface area (BSA) for ascending and descending aorta, separately, and for each group, the mean, standard deviation, and upper normal limit were calculated for aortic diameter as well as for the calculated cross-sectional aortic area. Also, linear regression models were used to create BSA versus aortic diameter nomograms by age groups, and a formula for calculating predicted aortic size by age, gender, and BSA was created. Results Age, BSA, gender, and hypertension were directly associated with thoracic aorta dimensions. Additionally, diabetes was associated with ascending aorta diameter, and smoking was associated with descending aorta diameter. The mean diameters for the final analysis group were 33 ± 4 mm for the ascending and 24 ± 3 mm for the descending thoracic aorta, respectively. The corresponding upper limits of normal diameters were 41 and 30 mm, respectively. Conclusions Normal limits of ascending and descending aortic dimensions by noncontrast gated cardiac CT have been defined by age, gender, and BSA in a large, low-risk population of subjects undergoing CAC scanning.

Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area

Objective To define associated clinical conditions, pathology, natural history, and treatment outcome of nonhepatosplenic extramedullary hematopoiesis (NHS-EMH). Patients and Methods We retrospectively reviewed the medical charts of all patients identified as having NHS-EMH from 1975 to 2002. Diagnosis was made by tissue biopsy, fine-needle aspiration biopsy, or radionuclide bone marrow scanning. Results We identified 27 patients with antemortem diagnosis of NHS-EMH. The most common associated condition and disease site were myelofibrosis with myeloid metaplasia (MMM) (in 18 patients [67%]) and the vertebral column (in 7 patients [26%]; all involving the thoracic region), respectively. At the time of diagnosis of NHS-EMH, concurrent splenic EMH (in 22 patients [82%]; 15 [56%] had undergone splenectomy) and red blood cell transfusion dependency (in 12 patients [44%]) were prevalent. Of the 27 patients, 9 (33%) required no specific therapy. Specific therapy was radiation (in 7 patients with a 71% response rate) and surgical excision (in 6 patients with a 67% response). Treatment-associated complications were limited to surgery. Radiation therapy was not used in the non-MMM group, but low-dose radiation therapy was used in the MMM group for paraspinal or intraspinal EMH (median dose, 1 Gy; range, 1-10 Gy), pleural or pulmonary disease (median dose, 1.25 Gy; range, 1.00-1.50 Gy), and abdominal or pelvic disease (median dose, 2.02 Gy; range, 1.50-4.50 Gy). Median survival after the diagnosis of NHS-EMH was 13 months in the MMM group and 21 months in the non-MMM group. Conclusions This retrospective study suggests that NHS-EMH is rare, is often associated with MMM, and preferentially affects the thoracic spinal region. Asymptomatic disease may require no specific treatment, whereas symptomatic disease is best managed with low-dose radiation therapy.

Nonhepatosplenic Extramedullary Hematopoiesis: Associated Diseases, Pathology, Clinical Course, and Treatment

Malacoplakia: a study of the literature and current concepts of pathogenesis, diagnosis and treatment.

Cross-sectional cardiac anatomy was studied by computed tomography (CT) in normal patients and in patients with well documented cardiac pathology. Specific cardiac chambers, aortic and pulmonary artery enlargement, ventricular aneurysms, coronary artery, and intracardiac calcifications were demonstrated using a 3 sec scan time with and without intravenous iodinated contrast media. Although CT imaging of the heart is in its infancy, the clarity with which cardiac chambers and other structures were visualized is encouraging and suggests the potential value of CT scanning for detecting significant intracardiac pathology on routine thoracic CT scans.

CT demonstration of cardiac structures.

https://www.gastrojournal.org/article/S0016-5085(77)80030-9/pdf

Upper esophageal responses to intraluminal distention in man.

Malacoplakia. An electron-microscopic study: demonstration of bacilliform organisms in malacoplakic macrophages.

Computed tomographic (CT) cardiac imaging in vivo has been hampered by motion of the heart during its cardiac cycle A technique of post data-acquisition correlation of the angular projection data using the electrocardiogram as a reference signal is described This method produced seven "stop action" images of the heart and resulted in delineating morphological detail not recognizable on the conventional CT scan

Stop-action cardiac computed tomography.

In order to assess its potential uses in the staging and treatment planning of lymphoma, CT was performed in 27 newly diagnosed, previously untreated patients with Hodgkin's disease or non-Hodgkin's lymphoma; 18 staging laparotomies provided pathologic correlations. CT detected and defined disease in areas not well evaluated by conventional techniques (high para-aortic, mesenteric, splenic hilar nodes). CT interpretation of splenic size and weight correlated well with splenic weight confirmed at pathology. Nodules were identified in several spleens containing foci of lymphoma.

George S. Harell

Papers

CT demonstration of cardiac structures.

Upper esophageal responses to intraluminal distention in man.

Malacoplakia. An electron-microscopic study: demonstration of bacilliform organisms in malacoplakic macrophages.

Stop-action cardiac computed tomography.

CT-pathologic correlations in Hodgkin's disease and non-Hodgkin's lymphoma.