Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.

Aidonis Rammos

Vasileios Meladinis

Georgios Vovas

Dimitrios Patsouras

Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment&#x2014;A Systematic Review

<i>Introduction</i>. To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study.<i> Materials and Methods</i>. Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated.<i> Results</i>. In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.981pt" style="vertical-align:-0.3499298pt" id="M1" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 25.981 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,18.35,0)"><path id="g117-37" d="M535 290V340H323V533H265V340H52V290H265V84H323V290H535ZM535 -22V28H52V-22H535Z"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.444pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="28.8361838 -8.34882 15.444 8.69875"><g transform="matrix(.013,0,0,-0.013,28.886,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,38.09,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g></svg></span> mm and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.981pt" style="vertical-align:-0.3499298pt" id="M2" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 25.981 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g><g transform="matrix(.013,0,0,-0.013,18.35,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.444pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="28.8361838 -8.34882 15.444 8.69875"><g transform="matrix(.013,0,0,-0.013,28.886,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,38.09,0)"><use xlink:href="#g113-50"/></g></svg></span> mm in the liver and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.983pt" style="vertical-align:-0.3499298pt" id="M3" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 25.983 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><use xlink:href="#g113-56"/></g><g transform="matrix(.013,0,0,-0.013,18.352,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.444pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="28.838183800000003 -8.34882 15.444 8.69875"><g transform="matrix(.013,0,0,-0.013,28.888,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,35.128,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,38.092,0)"><use xlink:href="#g113-56"/></g></svg></span> mm and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.981pt" style="vertical-align:-0.3499298pt" id="M4" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 25.981 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,18.35,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.444pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="28.8361838 -8.34882 15.444 8.69875"><g transform="matrix(.013,0,0,-0.013,28.886,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,38.09,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg></span> mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact.<i> Conclusion</i>. A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.

Priya Bhattacharji

William Moore

Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study

<i>Background</i>. Clinical imaging guidelines (CIGs) are suitable tools to enhance justification of imaging procedures.<i> Objective</i>. To assess physicians’ knowledge on irradiation, their self-perception of imaging prescriptions, and the use of CIGs.<i> Materials and Methods</i>. A questionnaire of 21 items was self-administered between July and August 2016 to 155 referring physicians working in seven university-affiliated hospitals in Yaoundé and Douala (Cameroon). This pretested questionnaire based on imaging referral practices, the use and the need of CIGs, knowledge on radiation doses of 11 specific radiologic procedures, and knowledge of injurious effects of radiation was completed in the presence of the investigator. Scores were allocated for each question.<i> Results</i>. 155 questionnaires were completed out of 180 administered (86.1%). Participants were 90 (58%) females, 63 (40.64%) specialists, 53 (34.20%) residents/interns, and 39 (25.16%) general practitioners. The average professional experience was 7.4 years (1–25 years). The mean knowledge score was 11.5/59 with no influence of sex, years of experience, and professional category. CIGs users’ score was better than nonusers (means 14.2 versus 10.6; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg>). 80% of physicians (124/155) underrated radiation doses of routine imaging exams. Seventy-eight (50.3%) participants have knowledge on CIGs and half of them made use of them. “Impact on diagnosis” was the highest justification criteria follow by “impact on treatment decision.” Unjustified requests were mainly for “patient expectation or will” or for “research motivations.” 96% of interviewees believed that making available national CIGs will improve justification.<i> Conclusion</i>. Most physicians did not have appropriate awareness about radiation doses for routine imaging procedures. A small number of physicians have knowledge on CIGs but they believe that making available CIGs will improve justification of imaging procedures. Continuous trainings on radiation protection and implementation of national CIGs are therefore recommended.

Boniface Moifo

Ulrich Tene

Jean Roger Moulion Tapouh

Odette Samba Ngano

Justine Tchemtchoua Youta

Augustin Simo

Joseph Gonsu Fotsin

Knowledge on Irradiation, Medical Imaging Prescriptions, and Clinical Imaging Referral Guidelines among Physicians in a Sub-Saharan African Country (Cameroon)

The aim of this study was to assess with MRI morphometric ultrastructural changes in nerves affected by diabetic peripheral neuropathy (DPN). We used an MR micro-neurography imaging protocol and a semiautomated technique of tissue segmentation to visualize and measure the volume of internal nerve components, such as the epineurium and nerve fascicles. The tibial nerves of 16 patients affected by DPN and of 15 healthy volunteers were imaged. Nerves volume (NV), fascicles volume (FV), fascicles to nerve ratio (FNR), and nerves cross-sectional areas (CSA) were obtained. In patients with DPN the NV was increased and the FNR was decreased, as a result of an increase of the epineurium (FNR in diabetic neuropathy 0,665; in controls 0,699, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42943pt" id="M1" height="11.713pt" version="1.1" viewBox="-0.0498162 -8.28357 51.7943 11.713" width="51.7943pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g190-254" d="M248 635C97 635 43 457 43 311C43 153 97 -12 247 -12S450 166 450 312C450 466 397 635 248 635ZM246 603C337 603 361 452 361 312S337 20 248 20S132 172 132 313C132 452 156 603 246 603Z"/></g><g transform="matrix(.013,0,0,-0.013,29.014,0)"><path id="g190-45" d="M95 130C70 130 46 113 46 88C46 72 54 64 59 64C93 55 121 33 121 -3C121 -41 93 -68 44 -88L55 -117C117 -98 186 -56 186 22C186 91 131 130 95 130Z"/></g><g transform="matrix(.013,0,0,-0.013,31.978,0)"><use xlink:href="#g190-254"/></g><g transform="matrix(.013,0,0,-0.013,38.517,0)"><path id="g190-166" d="M465 179V225H369V632H330C227 497 124 346 29 205V179H289V107C289 37 284 33 198 26V0H454V26C374 33 369 37 369 107V179H465ZM289 225H92C156 335 222 430 287 520H289V225Z"/></g><g transform="matrix(.013,0,0,-0.013,45.122,0)"><use xlink:href="#g190-254"/></g></svg>). CSA was increased in subjects with DPN (12,84 mm<sup>2</sup> versus 10,22 mm<sup>2</sup>, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42943pt" id="M2" height="11.713pt" version="1.1" viewBox="-0.0498162 -8.28357 50.9331 11.713" width="50.9331pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g190-254"/></g><g transform="matrix(.013,0,0,-0.013,29.014,0)"><use xlink:href="#g190-45"/></g><g transform="matrix(.013,0,0,-0.013,31.978,0)"><use xlink:href="#g190-254"/></g><g transform="matrix(.013,0,0,-0.013,38.504,0)"><use xlink:href="#g190-254"/></g><g transform="matrix(.013,0,0,-0.013,44.796,0)"><path id="g190-232" d="M269 381C298 400 325 421 340 436C360 455 370 476 370 504C370 579 313 635 223 635H222C170 635 123 610 95 579L52 516L72 497C95 533 136 577 193 577C245 577 286 546 286 482C286 408 218 369 127 339L133 314C149 319 174 325 197 325C254 325 324 285 324 192C325 83 266 39 201 39C143 39 103 68 78 91C70 98 62 97 54 91C45 84 33 71 32 58C30 46 34 35 48 22C61 10 102 -12 148 -12C216 -12 410 57 410 225C410 298 357 362 269 379V381Z"/></g></svg>). The FV was increased in patients with moderate to severe DPN. We have demonstrated structural changes occurring in nerves affected by DPN, which otherwise are assessable only with an invasive biopsy. MR micro-neurography appears to be suitable for the study of microscopic changes in tibial nerves of diabetic patients. 

P. F. Felisaz

G. Maugeri

V. Busi

R. Vitale

F. Balducci

S. Gitto

P. Leporati

A. Pichiecchio

M. Baldi

F. Calliada

L. Chiovato

S. Bastianello

MR Micro-Neurography and a Segmentation Protocol Applied to Diabetic Neuropathy

<i>Introduction</i>. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB).<i> Method</i>. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/&#x2212; SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications.<i> Results</i>. There were fifty-five hospital admissions with acute unstable lower gastrointestinal bleeding which were demonstrable on CE-MDCT or RS over a 31-month period. Eighteen patients proceed to embolization, with immediate success in all. Eight patients (44&#x25;) had clinical rebleeding after intervention, warranting repeated imaging. Only one case (5.6&#x25;) demonstrated radiological rebleeding and was reembolized. Complication rate was excellent: no bowel ischaemia, ischaemic stricture, progression to surgery, or 30-day mortality.<i> Conclusion</i>. SMAE is a viable, safe, and effective first-line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted practice at our institution to manage localised LGIB with embolization.

Toan Pham

Bob Anh Tran

Kevin Ooi

Marcus Mykytowycz

Stephen McLaughlin

Matthew Croxford

Iain Skinner

Ian Faragher

Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding

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<p><em>Radiology Research and Practice</em> publishes articles on all areas of medical imaging. The journal promotes evidence-based radiology practice though the publication of original research and&nbsp;reviews for a multidisciplinary audience.</p>


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Radiology Research and Practice | Hindawi

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Radiology Research and Practice publishes articles on all areas of medical imaging. The journal promotes evidence-based radiology practice though the publication of original research and reviews for a multidisciplinary audience.

Radiology Research and Practice