Thoracic Imaging 2003 - Society of Thoracic Radiology

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March 4, 2003 General Session Tuesday 136 Session 2-B Concurrent Session Clinical & Academic Workplace Issues II Americana 4 Moderator: Jud Gurney, MD 10:50 - 11:10 Voice Recognition Theresa McLoud, MD 11:10 - 11:30 The Internet & the Practice of Radiology: A New Educational Paradigm Jud Gurney, MD 11:30 - 11:50 Session Discussion 11:50 - 1:00 pm Lunch (on your own) Workshops (choose 1) 1:00 - 1:45 A1: Lymphoma: Spectrum of Disease Americana 3 Kitt Shaffer, MD, PhD 1:00 - 1:45 A2: Digital Images: Camera to Powerpoint Americana 4 Eric Stern, MD 1:45 - 2:30 B1: Analysis of Mediastinal Contours Americana 3 James Reed, MD 2:30 - 3:15 C2: Unusual Manfestations of Lung Cancer Americana 4 Michelle Ginsberg, MD 3:15 – 3:30 pm Coffee Break Americana Foyer 3:30 – 5:30 pm Scientific Session I (non-CME Session) Moderators: Jeremy Erasmus, MD and Joel Fishman, MD, PhD 5:30 – 7:00 pm Fellow/Resident/Student Reception Venus Room
Adult Manifestations of Congenital Heart Disease Gregory Pearson, M.D., Ph.D. Objectives: 1) To review the MR and CT manifestations of congenital heart disease commonly seen in adult patients, including those that present in adulthood and those seen in adulthood after pediatric repair. 2) To familiarize radiologists with the relevant clinical questions for which adult congenital heart disease patients are referred. 3) To describe typical MR and CT protocols for the rapid and efficient evaluation of adult congenital patients. Introduction With recent advances in pediatric cardiac surgery, patients with severe congenital heart disease that would previously not have survived past infancy are now surviving into adulthood, necessitating that adult thoracic radiologists familiarize themselves with common postoperative appearances. In addition, less severe congenital cardiac defects may remain occult during infancy and present de novo in adulthood. It is thus important for the thoracic radiologist to have a familiarity with the common presentations of congenital heart disease in the adult patient. CT and MR imaging of the adult congenital patient has several advantages over the imaging of pediatric patients. Structures are larger and thus easier to see. Adult patients are more able to perform breath hold images, which greatly improves the resolution of small structures. In an infant or small child breath hold images require general anesthesia with intubation and timed pauses of the respirator. In addition, a postoperative adult patient will usually come with a history. A detailed history and review of previous imaging studies (MRI, echo, and catheterization) can allow the radiologist to specifically focus on the relevant clinical questions, thus greatly facilitating the performance of an exam. As many patients with complex congenital heart disease have undergone multiple surgical procedures, it is best to learn as much as possible about the expected anatomy before the patient goes on the table. This can save considerable “head-scratching” while the patient is in the scanner. Thus coordination with our colleagues in Cardiology is essential. I have divided congenital heart disease in the adult patient into three broad categories: the (usually) nonpathologic entities, pathologic entities with de novo adult presentation, and pathologic entities seen in the adult after pediatric palliation or correction. As my presentation is limited to 20 minutes, these will not all be covered in detail. (Usually) non-pathologic entities These lesions mostly fall into the category of vascular anomalies. Right sided aortic arch is usually discovered incidentally on review of chest films performed for unrelated reasons, seen as a right-sided indentation on the trachea and the lack of a visible left sided aortic arch. Most patients found incidentally will have an aberrant left subclavian artery, as most patients with mirror image branching will have associated congenital heart disease. Left arch with an aberrant right subclavian artery is also a common anomaly found in asymptomatic individuals. Occasionally, patients with aberrant subclavian arteries may present with dysphagia due to esophageal compression from the anomalous vessel or from an aortic diverticulum, but this is the exception rather than the rule. Other anomalies such as bovine arch (common origin of the bracheocephalic artery and the left common carotid) are perhaps better thought of as normal variants. These often show up as the last line in a CT report prefaced by the phrase “incidental note is made of…” Vascular anomalies may require no further evaluation, or can usually be well demonstrated in adults on CT, spin echo, and gradient echo MRI images. Venous anomalies are also occasionally seen within the chest. These include persistent left SVC, with or without a right SVC or a vein bridging the two bracheocephalic veins, an entity perhaps most commonly diagnosed after noting the anomalous course of a central venous catheter or pacemaker. This is also a common associated anomaly in complex congenital heart disease. Azygous continuation of the IVC also deserves mention, for although it most commonly occurs as an isolated incidental finding it is also highly associated with polysplenia syndrome, one of the heterotaxy syndromes, which in its mild forms can present in adulthood. As with arterial anomalies, venous anomalies are usually well demonstrated on CT and MR images. Abnormalities with de novo adult presentation Although most patients with VSD will present in infancy, small VSDs will sometimes present in adulthood, as do many patients with an ASD. The role of MR imaging is to attempt to define the size and location of the defect and the size and direction of the associated shunt. The high-pressure jet from a VSD can usually be easily visualized of double oblique short axis or 4 chamber ECG gated bright blood cine cardiac images. The size of the jet is highly dependent on the repetition times, with shorter TE leaving less time for spins to dephase and thus lower sensitivity for turbulent flow and a smaller jet. Thus standard (non-breath hold) cine images will demonstrate a larger jet than breath hold segmented k-space cine images, which are more sensitive than the newer steady state cine sequences (true FISP, balanced FFE, or FIESTA, depending on the MR manufacturer.) Since atrial pressure is much lower than ventricular pressure, and the interatrial septum is much thinner than the ventricular septum, the visualization of an ASD can be more problematic. Turbulent jets are not typically seen, and the interatrial septum may not be visualized in its entirety in normal individuals. An ASD can sometimes be revealed by eddy currents within the atria on cine sequences that traverse the expected location of the interatrial septum. In addition, shunts can be quantified by the use of velocity-encoded MR imaging. In velocity-encoded imaging, two cine images are generated at the same level, one of which shows the magnitude of blood flow (magnitude image) and the other the direction (phase image). By quantifying the flow in the aorta and the main PA, the shunt fraction can be calculated using commercially available software packages. 139 TUESDAY
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The Society of Thoracic Radiology T
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Dear Friends, Welcome to Miami Beac
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Continuing Medical Education Credit
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Warren B. Gefter, MD University of
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Ernest M. Scalzetti, MD SUNY Upstat
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Registration Hours Saturday, March
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Program Committee Ella A. Kazerooni
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Small Airway Disease Americana 3 Mo
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Benjamin Felson Memorial Lecture Am
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Session 2-B Concurrent Session Clin
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Workshops (choose 1) 1:00 - 1:45 D1
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Sunday
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March 2, 2003 General Session Sunda
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SUNDAY 46 One type of direct-readou
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CT-PET Imaging Suzanne Aquino, M.D.
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SUNDAY 58 an accompanying decreased
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SUNDAY 60 Radiofrequency Ablation i
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SUNDAY 62 17. Sewell PE, Vance RB.
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SUNDAY 64 cal ventilation will be r
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SUNDAY 66 radiologic, and histopath
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SUNDAY 68 application. The untreate
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SUNDAY 70 The Expanded Spectrum of
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SUNDAY 72 Hypersensitivity Pneumoni
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SUNDAY 74 Small Airway Diseases Mic
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SUNDAY 76 The “Head-cheese Sign
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SUNDAY 78 “Holes” in the Lung:
Page 53 and 54: SUNDAY 80 Pleural Effusions Gerald
Page 55 and 56: SUNDAY 82 Asbestos Related Pleural
Page 57 and 58: SUNDAY 84 Other Pleural Neoplasms S
Page 59 and 60: SUNDAY 86 Image-Guided Therapy of M
Page 61 and 62: Notes 88
Page 63 and 64: March 3, 2003 General Session 7:00
Page 65 and 66: Cardiac MRI: Established Indication
Page 67 and 68: Cardiac MRI: New Developments Gauth
Page 69 and 70: 5. The volume of contrast medium re
Page 71 and 72: Acute Aortic Syndrome Ernest M. Sca
Page 73 and 74: as well as separation of the cusps
Page 75 and 76: Pulmonary Veins: Imaging for Radiof
Page 77 and 78: Imaging of Cardiopulmonary Support
Page 79 and 80: plied to the hollow fibers by an ex
Page 81 and 82: swelling of the entire leg, calf sw
Page 83 and 84: Multi-channel Pulmonary CTA: New Te
Page 85 and 86: terminate scintigrams, CT correctly
Page 87 and 88: CT Strucural and Functional Imaging
Page 89 and 90: curves (TDCs) are generated by manu
Page 91 and 92: 7. Crawford T, Yoon C, Wolfson K, e
Page 93 and 94: 80. Fleischmann D, Rubin GD, Bankie
Page 95 and 96: 127 MONDAY
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Page 99 and 100: REFERENCES Bergin CJ, Rios G, King
Page 101 and 102: Notes 134
Page 103: March 4, 2003 General Session 7:00
Page 107 and 108: will usually display the limbs of t
Page 109 and 110: Imaging of the Pericardium Paul L.
Page 111 and 112: Cardiomyopathy Martin J. Lipton, M.
Page 113 and 114: TUESDAY 150 Nuclear Cardiology Upda
Page 115 and 116: TUESDAY 152 ties. The predominant 1
Page 117 and 118: TUESDAY 154 Imaging protocols: Util
Page 119 and 120: Manpower Shortage in Radiology: Sol
Page 121 and 122: 159 TUESDAY
Page 127 and 128: NIBIB Update for Thoracic Radiology
Page 129 and 130: vertically along the right atrium t
Page 131 and 132: Multidetector Pediatric Chest CT: P
Page 133 and 134: The Spectrum of Pulmonary Infection
Page 135 and 136: Immune deficiency occurs frequently
Page 137 and 138: TUESDAY 180 The Internet and the Pr
Page 139 and 140: TUESDAY 182 Workshop A1: Lymphoma:
Page 141 and 142: TUESDAY 184 Digital Images: Camera
Page 143 and 144: TUESDAY 186 Analysis of Mediastinal
Page 145 and 146: Unusual Manifestations of Lung Canc
Page 147 and 148: Wednesday
Page 149 and 150: March 5, 2003 General Session Wedne
Page 151 and 152: WEDNESDAY 208 principle is that “
Page 153 and 154: WEDNESDAY 210 years and a current o
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WEDNESDAY 212 lesions generally mim
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WEDNESDAY 214 capable of studying t
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WEDNESDAY 216 Small T1 Lung Cancer:
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WEDNESDAY 218 REFERENCES Seely JM,
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WEDNESDAY 220 Therefore, radiologis
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WEDNESDAY 222 sectional area varies
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WEDNESDAY 224 Lung Cancer Staging A
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Metastatic Disease to Lung Gordon L
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Thoracic Metastates from Osteosarco
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STR tutorial: Use of MD CT reconstr
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ogenic edema, fat embolism, heroin
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WEDNESDAY 236 Pulmonary Arterial Hy
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WEDNESDAY 238 pathological process,
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Thursday
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THURSDAY 250 Pulmonary Tuberculosis
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THURSDAY 252 1. Clinical criteria:
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THURSDAY 254 AIDS patients are also
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THURSDAY 256 Viral Infection on HRC
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THURSDAY 258 Imaging of Coccidioido
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THURSDAY 260 from the laryngeal sur
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THURSDAY 262 Inflammatory Diseases
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Virtual Endoscopy in the Thorax: Pr
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Notes 269 THURSDAY
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SECOND LEVEL THIRD LEVEL
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Thoracic Imaging 2003 - Society of Thoracic Radiology

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