title: Myocardial Fatty Foci in Adult Patients with Tuberous Sclerosis Complex: Association with Gene Mutation and Multiorgan Involvement.
abstract: OBJECTIVE
  To estimate the association between myocardial fatty foci (MFF) on chest computed tomographic (CT) images and type of gene mutation or multiorgan involvement in patients with tuberous sclerosis complex (TSC).
  
  
  METHODS
  This retrospective case-control study was approved by the ethics committee, which waived the need for patient consent. Forty-eight patients with definite TSC (41 women; mean age, 35 years ± 11 [standard deviation]) and 96 age- and sex-matched patients without TSC who had undergone chest CT were evaluated. Two blinded readers independently scored MFF as low-attenuation areas within the myocardium. Patient history, gene mutation, and multiorgan involvement were obtained from clinical records. Cohen κ, Mann-Whitney U, χ(2) or Fisher exact, Kruskal-Wallis, and Spearman statistics were calculated.
  
  
  RESULTS
  One or more MFF was detected in 50% (24 of 48) of patients with TSC; however, no MFF was detected in control patients (P < .001). MFFs were oval (62%, 15 of 24) or linear (38%, nine of 24) and involved the left ventricle in 13 patients and both ventricles in 24 patients (mostly the apical or midleft ventricle); median size was 127 mm(2). After four patients with TSC and unknown mutational status (two with MFF) were excluded, MFF was detected in 53% (10 of 19) of patients with TSC1 mutation, 65% (11 of 17) of patients with TSC2 mutation, and 12% (one of eight) of patients with TSC but without an identified mutation (P = .044). MFF presence was associated with brain (P = .011) and multiorgan (P = .008) involvement. The number of MFF per patient correlated with the degree of multiorgan involvement (P = .014). With MFF considered predictive of TSC, 50% (24of 48) sensitivity, 100% (96 of 96) specificity, 100% (24 of 24) positive predictive value, and 80% (96 of 120) negative predictive value were obtained.
  
  
  CONCLUSIONS
  MFF was highly specific for TSC. MFF presence was associated with TSC gene mutations and with brain or multiorgan involvement; their number per patient was correlated with the degree of multiorgan involvement.
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Silvia
authors.initials: S
authors.lastname: Tresoldi
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Alice
authors.initials: A
authors.lastname: Munari
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pompili
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistrelli
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Francesca
authors.initials: F
authors.lastname: La Briola
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Canevini
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Cornalba
authors.affiliation: From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli).
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014402:Tuberous Sclerosis / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology