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Biomedical subjects

F R Gutierrez

Publications and source records attributed to F R Gutierrez.

At least 19 recordsLinked to original sources
PubMed2005

Cardiac magnetic resonance imaging abnormalities in systemic lupus erythematosus: a preliminary report.

The purpose of this prospective, pilot study was to determine whether differences in myocardial T2 relaxivity can be identified among active systemic lupus erythematosus (SLE) patients with clinically suspected SLE myocarditis, other active SLE patients, inactive SLE patients and age and gender matched controls. Eleven consecutive female patients (six with active SLE and five with inactive SLE), and five age, gender and race matched healthy controls underwent imaging with echocardiography and cardiac magnetic resonance imaging (MRI). Echocardiographic measurements included left ventricular end diastolic (LVEDV) and end systolic volumes (LVESV), and mass (LVM) (all indexed to body mass); ejection fraction and cardiac output. The cardiac MRI measurement was the T2 relaxation time (an index of soft tissue signal, with higher levels suggestive of increased tissue water content). Patients with active SLE had significantly higher LVEDV and LVM than inactive SLE patients and healthy controls, and significantly larger LVESV than healthy controls. Myocardial T2 relaxation times were significantly higher in patients with active SLE compared to those with inactive SLE and to healthy controls, and remained higher even after excluding the two active SLE patients who had clinical myocarditis. The four active SLE patients who underwent repeat cardiac imaging studies after clinical improvement showed normalization of these myocardial abnormalities. The conclusion was that active SLE patients demonstrate abnormalities in myocardial structure manifested by high myocardial T2 relaxation times that normalized after clinical improvement in disease activity. These findings suggest that T2 relaxation values are a sensitive indicator of myocardial disease in patients with SLE and that myocardial T2 relaxation abnormality frequently occur in patients with active SLE, even in the absence of myocardial involvement by clinical criteria.

Adult↗
PubMed2001

Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis.

PURPOSE: To assess the usefulness of thin-section expiratory computed tomography (CT), as compared with that of thin-section inspiratory CT, in detecting airway obstruction and air trapping in pediatric lung transplant recipients with bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: Thin-section CT scans were obtained at full inspiration and end expiration in 21 pediatric lung transplant recipients with proved BOS and in 41 transplant recipients with normal airways. True diagnosis was based on pulmonary function test results. Inspiration CT scans were scored for extent of decreased attenuation of the lung parenchyma; expiration CT scans were scored for extent of air trapping. RESULTS: The sensitivity of inspiratory CT for enabling diagnosis of BOS was 71%; the specificity, 78%; the positive predictive value, 62%; and the negative predictive value, 84%. The sensitivity of expiratory CT for enabling diagnosis of BOS was 100%; the specificity, 71%; the positive predictive value, 64%; and the negative predictive value, 100%. Expiratory CT scores correlated more strongly (rho = 0.75, P <.01) with pulmonary function test-based scores than did inspiratory CT scores (rho = 0.48, P <.01). Nominal logistic regression analysis revealed that expiratory CT was a more powerful predictor of true diagnosis (P <.01) than was inspiratory CT (P =.10). CONCLUSION: Expiratory CT is sensitive for depicting BOS-related airway abnormalities and may be more useful than inspiratory CT for diagnosis of small airway obstruction.

Adolescent↗
PubMed1998

Detection of CT-proved pulmonary nodules: comparison of selenium-based digital and conventional screen-film chest radiographs.

PURPOSE: To compare hard-copy digital chest radiographs obtained with a selenium-based system with wide-latitude asymmetric screen-film radiographs for detection of pulmonary nodules. MATERIALS AND METHODS: Fifty patients undergoing thoracic computed tomography (CT) for suspected pulmonary nodules were recruited to undergo both digital and screen-film posteroanterior (PA) and lateral chest radiography. Three chest radiologists blinded to the CT results independently reviewed each digital and screen-film radiograph, identified each nodule, and graded their confidence for its presence. RESULTS: Seventy-eight pulmonary nodules (mean diameter, 1.5 cm; range, 0.5-3.5 cm; 62 soft tissue, 16 calcified) were identified with CT in 34 patients, while 16 patients had clear lungs. The mean sensitivity for the detection of all nodules by all readers (PA and lateral) was 66% (95% Cl, 54%, 76%) for digital radiographs and 64% (95% Cl, 52%, 74%) for screen-film radiographs. Differences between the two techniques were not statistically significant (P > .05, Student t test). There was no difference in mean false-positive-true-positive ratios (PA, 0.35; lateral, 0.53) or positive predictive values (PA, 74%; lateral, 65%), and no significant difference (P > .05) was seen in mean reader confidence rating. CONCLUSION: In detecting pulmonary nodules, radiologists perform comparably with selenium-based digital and wide-latitude asymmetric screen-film radiographs.

Adult↗
PubMed1998

Detection of coronary stenoses on source and projection images using three-dimensional MR angiography with retrospective respiratory gating: preliminary experience.

OBJECTIVE: Our objective was to study the ability of three-dimensional MR angiography with retrospective respiratory gating to reveal stenoses in proximal coronary arteries on source and projection images. CONCLUSION: Proximal coronary artery stenoses can be identified using three-dimensional MR angiography with retrospective respiratory gating, both with projection images and on source images alone. Reasons for missed lesions included collateral vessels and retrograde flow distal to complete occlusion and volume averaging of vessels with adjacent structures. Causes of false-positive interpretations included small foci of decreased signal intensity distal to complete occlusion, partial volume effects on individual partitions, and regions of distal vessels leaving the imaging plane.

Aged↗
PubMed1997

Transesophageal echocardiographic and clinical features of aortic intramural hematoma.

OBJECTIVE: This study sought to determine the transesophageal echocardiographic features and natural history of patients with aortic intramural hematoma. METHODS: The transesophageal echocardiograms of all patients who had symptoms indicative of aortic dissection over 6 years were reviewed. Measurements were made of the involved aortic segment in the study patients, and follow-up was obtained. RESULTS: In patients with aortic intramural hematoma, the wall thickness of the involved segment was significantly greater for descending segments than ascending segments (ascending aorta 7 +/- 2 mm, descending aorta 15 +/- 6 mm, p = 0.0016). In each case, the crescent-shaped intramural hematoma involved one wall predominantly, leading to compression of the aortic lumen. The findings of echolucent areas and displaced intimal calcium were found in the majority of patients. Four of eight patients with intramural hematoma of the ascending aorta were treated medically and four were treated surgically. The 30-day mortality was 50% in the medically treated patients and 0% in the surgically treated group. Four of 11 patients with isolated intramural hematoma of the descending aorta were treated medically and seven were treated surgically. All medically treated and 86% of surgically treated patients were alive at 30 days. CONCLUSIONS: Aortic intramural hematoma has distinct and identifiable transesophageal echocardiographic features. These data support those of previous studies documenting high morbidity and mortality in patients with aortic intramural hematoma.

Aged↗
PubMed1997

Vascular rings in symptomatic children: frequency of chest radiographic findings.

PURPOSE: To determine the relative frequency of radiographic findings in symptomatic children with vascular rings. MATERIALS AND METHODS: Preoperative chest radiographs in 41 children (mean age, 21 months) with surgically proved vascular rings were retrospectively analyzed. There were 41 frontal and 39 lateral radiographs. Lateral views were evaluated for retrotracheal opacity, tracheal narrowing, and anterior tracheal bowing. The aortic arch, descending aorta, and tracheal indentation were assessed on frontal views. RESULTS: Findings on 39 lateral radiographs included increased retrotracheal opacity on 31 (79%), anterior tracheal bowing on 36 (92%), and tracheal narrowing on 30 (77%) radiographs. All findings were present on 24 (62%) radiographs. Findings on 41 frontal radiographs included right aortic arch on 35 (85%), distal tracheal indentation on 30 (73%), and right descending aorta on 27 (66%) radiographs. All findings were present on 20 (49%) radiographs. Four (10%) frontal radiographs were normal or indeterminate. The combination of frontal and lateral views showed at least one abnormality in every patient. No symptomatic patient with a vascular ring had a normal radiograph. CONCLUSION: A normal chest radiograph is evidence against the presence of a vascular ring in symptomatic children. Both lateral and frontal radiographs are important in diagnosis.

Aorta, Thoracic↗
PubMed1996

Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging.

PURPOSE: To determine how often emboli detected angiographically in peripheral pulmonary arterial branches would be missed with cross-sectional imaging. MATERIALS AND METHODS: Seventy-nine of 88 consecutive pulmonary angiograms interpreted as positive for pulmonary emboli were reviewed retrospectively to detect pulmonary emboli. Three angiograms interpreted as negative when reviewed retrospectively were excluded. Findings of 76 angiograms in 76 patients (32 men, 44 women; aged 19-85 years) were correlated with the results of scintigraphy (n = 72) and Doppler ultrasound (n = 60), clinical presentation (n = 76), and follow-up with chart review (n = 72). RESULTS: Two hundred five emboli were identified. Nineteen patients had solitary emboli. Sixty emboli were in the upper lobes. The largest arterial branch with pulmonary embolism was lobar in 14 patients, segmental in 38, subsegmental in 20, and smaller in three. CONCLUSION: If cross-sectional imaging can depict emboli in only segmental and larger arterial branches, then emboli in 23 of 76 patients (30%) would have been missed with cross-sectional imaging.

Female↗
PubMed1996

Coronary arteries: three-dimensional MR imaging with retrospective respiratory gating.

Thin-section, three-dimensional (3D) gradient-echo magnetic resonance imaging of the coronary arteries was performed without and with retrospective respiratory gating in 12 healthy volunteers and one patient. In all examinations, results were improved with gating. In five of seven volunteer examinations, coronary artery delineation on images reconstructed by using the least-squares method for motion detection with navigator echoes was found to be equal to that obtained by using edge detection. Images in five other volunteers covered the entire heart with multiple overlapping 3D slabs. The arteries were segmented from the background and could be viewed from any orientation. The lengths of contiguously visible vessels were as follows: left main coronary artery, 11.5 mm +/- 0.4 (mean +/- standard deviation); left anterior descending branch, 115.9 mm +/- 19.7; left circumflex branch, 97.2 mm +/- 12.5; and right coronary artery, 125.9 mm +/- 18.8. This respiratory gating technique clearly improved depiction of the coronary arteries.

Adult↗
PubMed1995

Magnetic resonance imaging of congenital heart disease.

Magnetic resonance imaging plays a very important role in the noninvasive evaluation of patients with congenital heart defects. The purpose of this article is to address the practical application of this technology to patients with congenital heart defects. Issues related to patient monitoring, image interpretation, and specific applications in different disease entities are also discussed.

Heart Defects, Congenital↗
PubMed1994

Comparison of ventricular mass and function in early versus late repair of coarctation of the aorta.

Left ventricular (LV) mass and function in 11 patients (group I) with coarctation of the aorta repaired at a mean age of 35 days were compared with that of 14 patients (group II) who underwent repair at a mean age of 8 years. Each group was compared to age- and sex-matched normal control subjects. All patients were normotensive and had resting arm-leg peak systolic blood pressure gradients < 20 mm Hg. Quantitative M-mode echocardiography was used to determine LV mass index and systolic performance. Magnetic resonance imaging was performed to assess residual narrowing of the descending aorta. LV mass index was increased in both groups when compared with control subjects (group I p = 0.01; group II p = 0.007). Whereas systolic performance in group I was similar to its control group, group II patients had enhanced LV systolic performance as measured by shortening fraction (p = 0.007). Multiple regression analysis of combined group I and II patients demonstrated a significant positive correlation of residual aortic narrowing with LV mass index (p = 0.01). Thus, LV mass remains increased in normotensive patients without major blood pressure gradients after repair of coarctation of the aorta in infancy or childhood. Small degrees of residual aortic narrowing were associated with increased postoperative LV mass regardless of the age at repair.

Adolescent↗
PubMed1994

Aortic dissection: effect of prospective chest radiographic diagnosis on delay to definitive diagnosis.

PURPOSE: To determine the effect of the interpretation of plain chest radiographs on the time to definitive diagnosis of aortic dissection. MATERIALS AND METHODS: The authors evaluated chest radiographs from 75 patients in whom chest radiography was performed before aortic dissection was diagnosed. The radiographs and available comparison images were retrospectively reviewed to identify cases in which aortic dissection should have been suggested before the diagnosis was made. RESULTS: Radiographic reports suggested that only 19 patients (25%) had an aortic dissection or thoracic aortic aneurysm or needed additional imaging of the aorta. No statistically significant correlation existed between interpretation of the chest radiographs and delay to diagnosis, type of dissection, availability of previously obtained images, or presence of characteristic clinical symptoms. Retrospective analysis showed that the chest radiographs of 36 patients (48%) contained sufficient findings to suggest the diagnosis. In five patients, failure to prospectively suggest dissection was associated with a delay to diagnosis of more than 24 hours. CONCLUSION: Although prospective interpretation of the chest radiograph shortened the delay to definitive diagnosis for only a limited number of patients, retrospective analysis suggests that the delay can be shortened for additional patients.

Aortic Dissection↗
PubMed1994

Radiologic appearance of implantable cardiac defibrillators.

Since the original descriptions of the radiologic appearance of implantable cardiac defibrillators by Lurie et al. [1] and Goodman et al. [2] in 1985, rapid growth has occurred in the complexity and variety of models available. Originally, all devices were surgically placed in or on the pericardium. Now, some devices are inserted by intravascular catheters with part of the device buried in the chest wall, avoiding the need for thoracotomy. Initially, these devices were used as defibrillators for treatment of tachyarrythmia and ventricular fibrillation. Now they serve as pacemakers for both tachy- and bradyarrhythmias and can act as cardioverters or defibrillators if required. Radiologists must be familiar with the appearances of these devices as their use becomes more widespread. In this article, the electrophysiology of these devices is briefly reviewed and the typical radiologic appearances are presented along with common radiologically recognizable complications.

Adult↗
PubMed1993

Early results after pediatric cardiac transplantation with triple immunosuppression therapy.

Pediatric heart transplant recipients were previously reported to have higher early mortality and morbidity than do adult patients treated with triple immunosuppression therapy (steroids, azathioprine and cyclosporine). Nineteen patients (11 infants and 8 older children) underwent orthotopic transplantation using triple immunosuppression therapy. Surveillance for cellular rejection and coronary arteriopathy was performed with endomyocardial biopsy and selective coronary angiography in all patients, with continuous monitoring for hypertension and serious infection. Seventeen of 19 patients (89%; 10 infants and 7 older children) are current survivors, with a median follow-up of 29 months (range 17 to 94). There were 5 and 7 episodes of rejection in the first 12 months after transplantation in the infant and older groups, respectively, for actuarial freedom-from-rejection rates of 65% at 3 months and 54% at 12 months. Severe coronary arteriopathy was detected in 1 infant 11 months after transplantation. In the first 12 months after transplantation, there were 3 hospitalizations for infection, and 2 patients needed treatment for hypertension in the infant group, compared with 1 hospitalization for infection, and 4 patients on antihypertensives in the older group. An increased prevalence of noninfectious complications in the infant group led to significantly longer postoperative stays than in the older group (mean 27.3 vs 19.4 days; p < 0.05). The results indicate that cardiac transplantation using triple immunosuppression therapy in infants, children and adolescents is associated with a high survival rate, and low rates of rejection and serious infection.

Actuarial Analysis↗
PubMed1993

MR and CT diagnosis of carcinoid heart disease.

This report describes findings present on magnetic resonance (MR) imaging and computed tomography (CT) in a patient with carcinoid heart disease. Major abnormalities included thickening and immobility of the tricuspid valve leaflets and disturbed flow patterns indicative of tricuspid stenosis and regurgitation demonstrated with cine MR. While echocardiography is usually the initial imaging modality in patients with carcinoid heart disease, other modalities such as MR and CT may provide correlative or supplemental information.

Carcinoid Heart Disease↗