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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Krittayaphong R, Zhang S, Tanapibunpon P, Kaolawanich Y, Nakyen S. Dark-blood late gadolinium-enhancement cardiac magnetic resonance imaging for myocardial scar detection based on simplified timing scheme: single-center experience in patients with suspected coronary artery disease. Quant Imaging Med Surg 2022; 12:1037-1050. [PMID: 35111603 DOI: 10.21037/qims-21-704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
Background This study aims to examine scar detectability using dark-blood late gadolinium enhancement (LGE) with simplified timing scheme and fixed parameters comparing to two conventional bright-blood approaches in patients with known or suspected coronary artery disease. Methods Three LGE techniques were performed in all patients with known or suspected coronary artery disease at 3 T: dark blood two-dimensional (2D) phase-sensitive inversion recovery (PSIR) preceded with a T2-preparation pulse (DB-LGE), conventional three-dimensional (3D) gradient-echo inversion recovery (3D-IR) and conventional 2D PSIR. Timing parameters in DB-LGE were tested in five clinically confirmed coronary artery disease patients with scars and fixed for the rest of the study. Two independent readers evaluated images at both patient and segment levels. Image quality and contrast ratio between scar and adjacent tissues were assessed. Concordance between the three techniques and detection rate based on expert consensus were reported. Results Forty-six patients were recruited in the study (average age 66.8 years, 69.6% male). DB-LGE demonstrated superior image quality (P=0.001 vs. 3D-IR) and scar-to-blood contrast ratio (P<0.001 vs. 3D-IR and PSIR). Among 41 patients with suspected coronary artery disease, myocardial scar was present in 30 patients (73.2%), all detected by DB-LGE, yielding a detection rate of 100% compared to 93.3% and 96.7% for bright-blood 3D-IR and PSIR. For subendocardial scar detection among 656 segments, DB-LGE had a detection rate of 99.4% compared to 57.8% for 3D-IR and 61.0% for PSIR (both P<0.001). Conclusions DB-LGE improves detection of myocardial scar compared with conventional bright-blood LGE techniques, particularly of subendocardial scar.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shuo Zhang
- Philips Healthcare, Singapore.,Philips Healthcare, Hamburg, Germany
| | - Prajak Tanapibunpon
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaporn Nakyen
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Jung HN, Kim SM, Lee JH, Kim Y, Lee SC, Jeon ES, Yong HS, Choe YH. Comparison of tissue tracking assessment by cardiovascular magnetic resonance for cardiac amyloidosis and hypertrophic cardiomyopathy. Acta Radiol 2020; 61:885-893. [PMID: 31684748 DOI: 10.1177/0284185119883714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Administration of gadolinium-contrast can cause problems in cardiac amyloidosis (CA) patients with impaired renal function. PURPOSE To compare patterns of cardiovascular magnetic resonance tissue tracking (CMR-TT) for CA and hypertrophic cardiomyopathy (HCM) and to assess the feasibility of CMR-TT to distinguish between these diseases without administration of gadolinium-contrast. MATERIAL AND METHODS Included were 54 patients with biopsy-proven CA, 40 patients with HCM, and 30 healthy people. We calculated strain ratio of apex to base (SRAB) in the left ventricle (LV) using radial (R), circumferential (C), and longitudinal (L) strain from CMR-TT. The LV ejection fraction (LVEF) and the ratio of septal to posterior wall at basal level were also calculated. Late gadolinium enhancement (LGE) image analysis was performed for differential diagnosis. Area under the receiver operating characteristic curve (AUC) comparisons were used. RESULTS All SRAB values were significantly different between CA and HCM (all P < 0.001). AUC values for parameters were 0.806 for LVEF, 0.815 for ratio of wall thickness, 0.944 for the LGE pattern, 0.898 for SRABR, 0.880 for SRABC, and 0.805 for SRABL. AUCs for the LGE pattern were significantly higher than for LVEF, ratio of wall thickness and SRABL (all P < 0.008). No significant differences were seen between AUCs for the LGE pattern, SRABR, and SRABC (all P > 0.109). CONCLUSION SRABR and SRABC were reliable parameters for distinguishing between CA and HCM.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Current affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yiseul Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hwan Seok Yong
- Current affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
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Ventricular fibrillation in rheumatoid arthritis. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
T1 or longitudinal relaxation time is one of the very fundamental magnetic resonance imaging (MRI) time constants and a tissue characterizing parameter. Only during the last decade did it become possible to quantify T1 values of the myocardium through T1 mapping. Evolving from only region of interest analysis and long acquisition times to the pixel-based parametric mapping and short breath-hold sequences, T1 mapping is reaching maturity among cardiac magnetic resonance (CMR) techniques. Both inversion recovery methods such as MOdified Look-Locker Inversion (MOL-LI) and Shortened MOLLI (ShMOLLI) and saturation recovery methods such as Saturation recovery Single-Shot Acquisition (SASHA) are available for T1 quantification with variable degrees of accuracy, precision, and reproducibility. Native (non-contrast) T1 values increase with edema, amyloid deposition, and fibrosis, while they decrease in fat or iron deposition in the myocardium. These features enabled significant expansion of the clinical applications of native T1 mapping where it provides high sensitivity and specificity and even acts as a disease biomarker or a predictor of prognosis. It is of particular usefulness in diffuse myocardial diseases where conventional CMR techniques might be deceiving. A brighter future for the technique is expected if certain challenges are to be faced, examples of which are the need for standardization of normal values, acquisition techniques, and improving analysis tools.
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Affiliation(s)
- Ahmed Hamdy
- Department of Radiology, Mie University Hospital
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Perea Palazón R, Ortiz Pérez J, Prat González S, de Caralt Robira T, Cibeira López M, Solé Arqués M. Parametric techniques for characterizing myocardial tissue through magnetic resonance imaging (Part 1): T1 mapping. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cannaò PM, Altabella L, Petrini M, Alì M, Secchi F, Sardanelli F. Novel cardiac magnetic resonance biomarkers: native T1 and extracellular volume myocardial mapping. Eur Heart J Suppl 2016; 18:E64-E71. [DOI: 10.1093/eurheartj/suw022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Detection of Cardiac Function Abnormality from MRI Images Using Normalized Wall Thickness Temporal Patterns. Int J Biomed Imaging 2016; 2016:4301087. [PMID: 27034648 PMCID: PMC4791492 DOI: 10.1155/2016/4301087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 01/19/2023] Open
Abstract
Purpose. To develop a method for identifying abnormal myocardial function based on studying the normalized wall motion pattern during the cardiac cycle. Methods. The temporal pattern of the normalized myocardial wall thickness is used as a feature vector to assess the cardiac wall motion abnormality. Principal component analysis is used to reduce the feature dimensionality and the maximum likelihood method is used to differentiate between normal and abnormal features. The proposed method was applied on a dataset of 27 cases from normal subjects and patients. Results. The developed method achieved 81.5%, 85%, and 88.5% accuracy for identifying abnormal contractility in the basal, midventricular, and apical slices, respectively. Conclusions. A novel feature vector, namely, the normalized wall thickness, has been introduced for detecting myocardial regional wall motion abnormality. The proposed method provides assessment of the regional myocardial contractility for each cardiac segment and slice; therefore, it could be a valuable tool for automatic and fast determination of regional wall motion abnormality from conventional cine MRI images.
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Perea Palazón RJ, Ortiz Pérez JT, Prat González S, de Caralt Robira TM, Cibeira López MT, Solé Arqués M. Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping. RADIOLOGIA 2016; 58:164-77. [PMID: 26944850 DOI: 10.1016/j.rx.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 11/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations.
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Affiliation(s)
- R J Perea Palazón
- Servicio de Radiodiagnóstico, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - J T Ortiz Pérez
- Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - S Prat González
- Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - T M de Caralt Robira
- Servicio de Radiodiagnóstico, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M T Cibeira López
- Servicio de Hematología, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Solé Arqués
- Servicio de Anatomía Patológica, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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Fronza M, Raineri C, Valentini A, Bassi EM, Scelsi L, Buscemi ML, Turco A, Castelli G, Ghio S, Visconti LO. Relationship between electrocardiographic findings and Cardiac Magnetic Resonance phenotypes in patients with Hypertrophic Cardiomyopathy. IJC HEART & VASCULATURE 2016; 11:7-11. [PMID: 28616518 PMCID: PMC5462632 DOI: 10.1016/j.ijcha.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/09/2016] [Accepted: 02/21/2016] [Indexed: 12/31/2022]
Abstract
Background Q waves and negative T waves are common electrocardiographic (ECG) abnormalities in patients with Hypertrophic Cardiomyopathy (HCM). Several studies correlated ECG findings with presence and extent of fibrosis and hypertrophy; however, their significance remains incompletely clarified. Our study aimed to explain the mechanism behind Q and negative T waves by comparing their positions on a 12-lead ECG with phenotypes observed at Late Gadolinium Enhancement (LGE) Cardiac Magnetic Resonance (CMR). Methods 12-lead ECG and LGE-CMR were performed in 88 consecutive patients with HCM (42 SD 16 years, 65 males). Using Delta Thickness ratio (DT ratio), and “global” and “parietal” LGE at CMR, the extent and distribution of myocardial hypertrophy and fibrosis were studied in correlation with ECG abnormalities. Results Q waves in different leads were not associated with “parietal” LGE score. Lateral Q waves correlated with an increased DT ratio Inferior Septum/Lateral wall (p = 0.01). A similar correlation between inferior Q waves and an increased DT Ratio Anterior wall/Inferior wall was of borderline statistical significance (p = 0.06). As expected, ECG signs of LV hypertrophy related to a raised Left Ventricular Mass Index (LVMI) (p < 0.0001) and mean wall thickness (p = 0.01). Depolarization disturbances, including negative T waves in lateral (p = 0.044) and anterior (p = 0.031) leads correlated with “parietal” LGE scores while QT dispersion (p = 0.0001) was associated with “global” LGE score. Conclusion In HCM patients, Q waves are generated by asymmetric hypertrophy rather than by myocardial fibrosis, while negative T waves result from local LGE distribution at CMR.
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Affiliation(s)
- Matteo Fronza
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Claudia Raineri
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Adele Valentini
- Institute of Radiology, University of Pavia School of Medicine, Pavia, Italy
| | - Emilio Maria Bassi
- Institute of Radiology, University of Pavia School of Medicine, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Maria Laura Buscemi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Grazia Castelli
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico S Matteo, Pavia, Italy
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Jin H, Yun H, Ma J, Chen Z, Chang S, Zeng M. Coronary Microembolization with Normal Epicardial Coronary Arteries and No Visible Infarcts on Nitrobluetetrazolium Chloride-Stained Specimens: Evaluation with Cardiac Magnetic Resonance Imaging in a Swine Model. Korean J Radiol 2016; 17:83-92. [PMID: 26798220 PMCID: PMC4720817 DOI: 10.3348/kjr.2016.17.1.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/15/2015] [Indexed: 01/16/2023] Open
Abstract
Objective To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. Materials and Methods Eleven pigs underwent intracoronary injection of small-sized microspheres (42 µm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. Results Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 ± 2.0% at baseline to 20.3 ± 2.3% at 6 hours and 31.5 ± 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. Conclusion Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.
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Affiliation(s)
- Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.; Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hong Yun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.; Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Zhangwei Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Shufu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.; Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Jin H, Yun H, Ma JY, Chen ZW, Chang SF, Ge MY, Zeng MS. Assessment of the acute effects of glucocorticoid treatment on coronary microembolization using cine, first-pass perfusion, and delayed enhancement MRI. J Magn Reson Imaging 2015; 43:921-8. [PMID: 26361889 DOI: 10.1002/jmri.25049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/01/2015] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess the acute effects of methylprednisone treatment (MPT) on coronary microembolization (CME) by cardiac cine, first-pass perfusion, and delayed gadolinium enhancement magnetic resonance imaging (DE-MRI) in an experimental swine model. MATERIALS AND METHODS Microembolization was established by intracoronary infusion of microspheres into the left anterior artery. Swine received placebo (n = 12) or methylprednisolone (n = 10, 30 mg/kg) intravenously 30 minutes before microembolization. Perfusion and DE-MRI was performed 6 hours after microembolization. Cine MR images of pre-/post-CME were obtained using 1.5T scanner. RESULTS Cine MRI demonstrated relative amelioration of the post-CME myocardial contractile dysfunction in the glucocorticoid-treated group compared to the placebo group (P < 0.001). Post-CME target myocardial perfusion parameters decreased in both groups after microembolization. The extent of these decreases were the same for the embolized-to-control area ratio of maximum upslope (P = 0.245; 95% confidence interval of the difference [CID], -0.041/0.148) and time to peak ratio (P = 0.122; 95% CID, -0.201/0.026); however, the maximum signal intensity was higher in the glucocorticoid-treated group (P = 0.012; 95% CID, 0.023/0.156). DE-MRI revealed patchy hyperenhancement in all placebo pigs (n = 12/12) after microembolization, but no hyperenhanced regions in the glucocorticoid-pretreated pigs (n = 0/10). CONCLUSION Standard, readily available, cardiac MRI techniques are useful in demonstrating post-CME myocardial dysfunction and the acute effects of glucocorticoid treatment on CME. Glucocorticoid pretreatment improves myocardial contractile dysfunction, prevents hyperenhancement, and partially ameliorates the decline of myocardial perfusion in the embolized area.
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Affiliation(s)
- Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Yun
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian-ying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Zhang-wei Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Shu-fu Chang
- Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Mei-ying Ge
- Department of Radiology, the 5th people's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Meng-su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, China
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Hamlin SA, Henry TS, Little BP, Lerakis S, Stillman AE. Mapping the future of cardiac MR imaging: case-based review of T1 and T2 mapping techniques. Radiographics 2015; 34:1594-611. [PMID: 25310419 DOI: 10.1148/rg.346140030] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiac magnetic resonance (MR) imaging has grown over the past several decades into a validated, noninvasive diagnostic imaging tool with a pivotal role in cardiac morphologic and functional assessment and tissue characterization. With traditional cardiac MR imaging sequences, assessment of various pathologic conditions ranging from ischemic and nonischemic cardiomyopathy to cardiac involvement in systemic diseases (eg, amyloidosis and sarcoidosis) is possible; however, these sequences are most useful in focal myocardial disease, and image interpretation relies on subjective qualitative analysis of signal intensity. Newer T1 and T2 myocardial mapping techniques offer a quantitative assessment of the myocardium (by using T1 and T2 relaxation times), which can be helpful in focal disease, and demonstrate special utility in the evaluation of diffuse myocardial disease (eg, edema and fibrosis). Altered T1 and T2 relaxation times in disease states can be compared with published ranges of normal relaxation times in healthy patients. In conjunction with traditional cardiac MR imaging sequences, T1 and T2 mapping can limit the interpatient and interstudy variability that are common with qualitative analysis and may provide clinical markers for long-term follow-up.
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Affiliation(s)
- Scott A Hamlin
- From the Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging (S.A.H., T.S.H., B.P.L., A.E.S.), and Department of Cardiology (S.L.), Emory University School of Medicine, 1364 Clifton Rd NE, Room D125A, Atlanta, GA 30322
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Imaging of reperfused intramyocardial hemorrhage with cardiovascular magnetic resonance susceptibility weighted imaging (SWI). PLoS One 2015; 10:e0123560. [PMID: 25875478 PMCID: PMC4395374 DOI: 10.1371/journal.pone.0123560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/04/2015] [Indexed: 01/24/2023] Open
Abstract
Purpose To report initial experience with TE-averaged susceptibility weighted imaging (SWI) in normal subjects and acute myocardial infarction (AMI) patients for the detection of intramyocardial hemorrhage (IMH). Materials and Methods 15 healthy control and 11 AMI subjects were studied at 1.5T before contrast agent administration with a dark blood double inversion recovery multiple spoiled gradient-echo sequence. Magnitude, susceptibility weighted and TE-averaged images were reconstructed from raw data. Contrast and signal-difference-to-noise were measured and compared between methods for IMH detection. Results There were six patients with microvascular obstruction (MVO) and four patients with IMH detected by TE-averaged SWI imaging. All patients with IMH on SWI scans had MVO on late gadolinium-enhanced (LGE) imaging. There was a three-fold increase in IMH contrast with SWI compared to magnitude images. IMH contrast decreased and signal-to-noise increased with increased TE averages. Conclusions TE-averaged SWI imaging is a promising method for myocardial tissue characterization in the setting of AMI for the detection of IMH. Along with gray-scale colormap inversion, it combines not only magnitude and phase information, but also images across TEs to provide a single image sensitive to IMH with characteristics similar to LGE imaging.
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Three-dimensional phase-sensitive inversion recovery sequencing in the evaluation of left ventricular myocardial scars in ischemic and non-ischemic cardiomyopathy: Comparison to three-dimensional inversion recovery sequencing. Eur J Radiol 2014; 83:2159-2166. [DOI: 10.1016/j.ejrad.2014.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/11/2014] [Accepted: 09/21/2014] [Indexed: 11/20/2022]
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Galea N, Francone M, Zaccagna F, Ciolina F, Cannata D, Algeri E, Agati L, Catalano C, Carbone I. Ultra low-dose of gadobenate dimeglumine for late gadolinium enhancement (LGE) imaging in acute myocardial infarction: A feasibility study. Eur J Radiol 2014; 83:2151-2158. [DOI: 10.1016/j.ejrad.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/08/2014] [Accepted: 09/01/2014] [Indexed: 01/10/2023]
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Mitsumori LM, Bhargava P, Essig M, Maki JH. Magnetic resonance imaging using gadolinium-based contrast agents. Top Magn Reson Imaging 2014; 23:51-69. [PMID: 24477166 DOI: 10.1097/rmr.0b013e31829c4686] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this article was to review the basic properties of available gadolinium-based magnetic resonance contrast agents, discuss their fundamental differences, and explore common and evolving applications of gadolinium-based magnetic resonance contrast throughout the body excluding the central nervous system. A more specific aim of this article was to explore novel uses of these gadolinium-based contrast agents and applications where a particular agent has been demonstrated to behave differently or be better suited for certain applications than the other contrast agents in this class.
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Abstract
Distinguishing the benign and malignant cardiac masses is usually a diagnostic challenge, and safe, non-invasive, and reliable techniques are necessary to avoid any delay in treatment. The previously described "sun ray" appearance is an important sign in the diagnosis of cardiac angiosarcoma, and in this report we present 3-T magnetic resonance imaging findings to distinguish the rare but fatal cardiac angiosarcoma.
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Meßner NM, Zöllner FG, Kalayciyan R, Schad LR. Pre-clinical functional Magnetic Resonance Imaging Part II: The heart. Z Med Phys 2014; 24:307-22. [PMID: 25023418 DOI: 10.1016/j.zemedi.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/09/2014] [Accepted: 06/17/2014] [Indexed: 12/21/2022]
Abstract
One third of all deaths worldwide in 2008 were caused by cardiovascular diseases (CVD), and the incidence of CVD related deaths rises ever more. Thus, improved imaging techniques and modalities are needed for the evaluation of cardiac morphology and function. Cardiac magnetic resonance imaging (CMRI) is a minimally invasive technique that is increasingly important due to its high spatial and temporal resolution, its high soft tissue contrast and its ability of functional and quantitative imaging. It is widely accepted as the gold standard of cardiac functional analysis. In the short period of small animal MRI, remarkable progress has been achieved concerning new, fast imaging schemes as well as purpose-built equipment. Dedicated small animal scanners allow for tapping the full potential of recently developed animal models of cardiac disease. In this paper, we review state-of-the-art cardiac magnetic resonance imaging techniques and applications in small animals at ultra-high fields (UHF).
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Affiliation(s)
- Nadja M Meßner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Raffi Kalayciyan
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Abstract
Imaging evaluation of the heart encompasses structural evaluation of the chambers, valves and coronary arteries, and functional evaluation, including assessment of perfusion, wall motion and myocardial viability. Magnetic resonance imaging is well established for the structural and functional evaluation of the heart, and benefits from direct multiplanar image acquisition and a lack of ionizing radiation. Magnetic resonance imaging assessment of myocardial viability after myocardial infarction appears to be helpful in predicting benefit from revascularization procedures. Magnetic resonance imaging continues to hold promise as the least invasive method of coronary artery evaluation, and continuing developments are improving image quality and decreasing examination time. The development of cardiac-gating techniques for multidetector computed tomography has the potential to provide widespread availability of cardiac computed tomography. Short examination times and straightforward scanning procedures promise a convenient method for the examination of cardiac structure and function. However, this convenience must be balanced against radiation dose and contrast-media requirements when determining the appropriate use of cardiac computed tomography. Computed tomography coronary-calcium scoring can aid in the prediction of significant coronary events in all but the lowest-risk patients. The high negative-predictive value of computed tomography coronary angiography may allow some patients to avoid cardiac catheterization, but its role in the assessment of patients with moderate coronary atherosclerosis remains unclear. New software tools can assist in the complex and tedious analysis of the large volumes of data produced by these examinations.
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Affiliation(s)
- Gregory W Gladish
- Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Box 57, Houston, TX 77030, USA.
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Smit H, Guridi RP, Guenoun J, Poot DHJ, Doeswijk GN, Milanesi M, Bernsen MR, Krestin GP, Klein S, Kotek G. T1 mapping in the rat myocardium at 7 tesla using a modified CINE inversion recovery sequence. J Magn Reson Imaging 2013; 39:901-10. [DOI: 10.1002/jmri.24251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/09/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- Henk Smit
- Departments of Medical Informatics and Radiology; Erasmus MC; Rotterdam The Netherlands
| | | | - Jamal Guenoun
- Department of Radiology; Erasmus MC; Rotterdam the Netherlands
| | - Dirk H. J. Poot
- Departments of Medical Informatics and Radiology; Erasmus MC; Rotterdam The Netherlands
| | | | | | - Monique R. Bernsen
- Department of Radiology; Erasmus MC; Rotterdam the Netherlands
- Department of Nuclear Medicine; Erasmus MC; Rotterdam the Netherlands
| | | | - Stefan Klein
- Departments of Medical Informatics and Radiology; Erasmus MC; Rotterdam The Netherlands
| | - Gyula Kotek
- Department of Radiology; Erasmus MC; Rotterdam the Netherlands
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Olimulder MAGM, Galjee MA, van Es J, Wagenaar LJ, von Birgelen C. Contrast-enhancement cardiac magnetic resonance imaging beyond the scope of viability. Neth Heart J 2013; 19:236-45. [PMID: 21541837 PMCID: PMC3087018 DOI: 10.1007/s12471-011-0084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The clinical applications of cardiovascular magnetic resonance imaging with contrast enhancement are expanding. Besides the direct visualisation of viable and non-viable myocardium, this technique is increasingly used in a variety of cardiac disorders to determine the exact aetiology, guide proper treatment, and predict outcome and prognosis. In this review, we discuss the value of cardiovascular magnetic resonance imaging with contrast enhancement in a range of cardiac disorders, in which this technique may provide insights beyond the scope of myocardial viability.
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Affiliation(s)
- M A G M Olimulder
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, the Netherlands
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Song BG, Yang HS, Hwang HK, Kang GH, Park YH, Chun WJ, Oh JH. Correlation of electrocardiographic changes and myocardial fibrosis in patients with hypertrophic cardiomyopathy detected by cardiac magnetic resonance imaging. Clin Cardiol 2012; 36:31-5. [PMID: 23070984 DOI: 10.1002/clc.22062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 08/31/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite several electrophysiologic and pathologic studies, the cause of electrocardiographic (ECG) changes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can detect myocardial fibrosis. We aimed to assess the relationship between ECG findings and LGE in such patients. HYPOTHESIS Myocardial LGE may be associated with ECG changes in HCM. METHODS Seventy consecutive patients with HCM (mean age, 55.5 ± 10.7 years; 47 males) underwent CMR and 12-lead ECG. The subjects were divided into 3 groups according to the type of hypertrophy: the asymmetric septal hypertrophy group (ASH group, n = 31), the apical hypertrophy group (AP group, n = 22), and concentric hypertrophy group (CH group, n = 17). The transmural and segmental extent, pattern, and location of myocardial LGE were assessed and analyzed in relation to ECG changes. RESULTS All of the subjects showed some degree of LGE on CMR. The AP group showed significantly higher prevalence of negative T-wave (P = 0.028) and deep negative T-wave inversion (P = 0.001) than the ASH and CH groups. The total volume of LGE did not show any significant association with ECG changes. LGE detected at the interventricular septum was associated with increased QRS duration (P = 0.009) and was found in 94% of the ASH group, 59% of the AP group, and 77% of the CH group. LGE at the apex of the heart was present in 32% of the ASH group, 73% of the AP group, and 35% of the CH group and was also associated with negative T-wave (P = 0.006) and deep negative T-wave inversion (P = 0.018). Multifocal LGE lesions were associated with increased QRS duration (P = 0.039) as opposed to single nodular or patchy pattern of presence. CONCLUSIONS The location of myocardial LGE in HCM shows significant association with various ECG changes. This may be useful information for initially evaluating subjects with HCM and adds pathophysiological insight into understanding ECG changes in myocardial diseases that cannot be explained otherwise.
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Affiliation(s)
- Bong Gun Song
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul
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The role of first-pass perfusion deficit in the detection of cardiac subendocardial manifestation in patients with autoimmune vasculitis. Rheumatol Int 2012; 33:29-35. [DOI: 10.1007/s00296-011-2310-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 12/10/2011] [Indexed: 11/25/2022]
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Secchi F, Di Leo G, Papini GD, Giacomazzi F, Di Donato M, Sardanelli F. Optimizing dose and administration regimen of a high-relaxivity contrast agent for myocardial MRI late gadolinium enhancement. Eur J Radiol 2011; 80:96-102. [DOI: 10.1016/j.ejrad.2010.06.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 06/17/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
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Qu X, Fang W, Ye J, Koh AS, Xu Y, Guan S, Li R, Shen Y. Acute and chronic myocardial infarction in a pig model: utility of multi-slice cardiac computed tomography in assessing myocardial viability and infarct parameters. Eur J Radiol 2011; 81:e431-7. [PMID: 21550194 DOI: 10.1016/j.ejrad.2011.03.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 03/13/2011] [Accepted: 03/16/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to determine the feasibility of multi-slice computed tomography (MSCT) biphasic imaging in assessing myocardial viability and infarct parameters in both acutely and chronically infarcted pig models. MATERIALS AND METHODS Seven pigs underwent ligation of the distal left anterior descending artery. Imaging was performed on the day of infarction and 3 months post-infarct, with contrast infusion followed by MSCT scan acquisition at different time-points. Left ventricular ejection fractions (LVEFs) were obtained by left ventriculography (LVG) after 3 months. Infarcted locations found using MSCT were compared with those obtained using SPECT. Infarcted areas were also analysed histopathologically and compared with the findings from MSCT. RESULTS Chronic phase images had perfusion defects with lower CT values relative to normal myocardium (43±10HU vs. 156±13HU, p=0.001) on the early images but no residual defects on delayed images. However, we found hyperenhancing regions on delayed images (244±20HU vs. 121±25HU, p=0.001), and good correlation between MSCT- and LVG-derived LVEFs (60.56±7.56%). The areas identified by MSCT corresponded to the location of (201)Tl SPECT-/pathologic staining-derived regions in all models. Infarct size was in good agreement with MSCT and pathological analyses of chronic phase models. CONCLUSIONS Necrotic myocardium in different stages after infarction could be qualitatively and quantitatively assessed using MSCT biphasic imaging, as could the status of microcirculation formation. MSCT-measured LVEFs matched well with other modalities, and hence MSCT is a useful tool in assessing post-infarct cardiac function.
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Affiliation(s)
- Xinkai Qu
- Department of Cardiology and Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241, West Huaihai Road, Shanghai, 200030, China
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Lefrançois W, Miraux S, Calmettes G, Pourtau L, Franconi JM, Diolez P, Thiaudière E. A fast black-blood sequence for four-dimensional cardiac manganese-enhanced MRI in mouse. NMR IN BIOMEDICINE 2011; 24:291-298. [PMID: 20925127 DOI: 10.1002/nbm.1588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 05/31/2010] [Accepted: 06/12/2010] [Indexed: 05/30/2023]
Abstract
The increasing number of mouse models of cardiac diseases requires improvements in the current MRI tools. Anatomic and functional cardiac phenotyping by MRI calls for both time and space resolution in three dimensions. Black-blood contrast is often needed for the accurate delineation of myocardium and chambers, and is consistent with manganese contrast enhancement. In this article, we propose a fast, three-dimensional, time-resolved (four-dimensional), black-blood MRI sequence that allows mouse heart imaging at 10 periods of the cardiac cycle within 30 min at an isotropic resolution of 200 µm. Two-dimensional imaging was possible within 80 s. Blood cancellation was achieved by employing bipolar gradients without the use of a double inversion recovery preparation scheme. Saturation slices were added in two-dimensional experiments for better blood nulling. The rapidity of the two-dimensional acquisition protocol allowed the measurement of the time course of contrast enhancement on manganese infusion. Owing to the very high contrast-to-noise ratio, manganese-enhanced MRI in four dimensions made possible the accurate assessment of regional cardiac volumes in healthy animals. In experimentally infarcted mice, the size of the ischemic zone could be measured easily with this method. The technique might be valuable in evaluating mouse heart diseases and their follow-up in longitudinal studies.
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Affiliation(s)
- William Lefrançois
- Centre de Résonance Magnétique des Systèmes Biologiques, CNRS/Université Victor Segalen Bordeaux 2, Bordeaux, France
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Li W, Griswold M, Yu X. Rapid T1 mapping of mouse myocardium with saturation recovery Look-Locker method. Magn Reson Med 2011; 64:1296-303. [PMID: 20632410 DOI: 10.1002/mrm.22544] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dynamic contrast-enhanced MRI using gadolinium or manganese provides unique characterization of myocardium and its pathology. In this study, an electrocardiography (ECG) triggered saturation recovery Look-Locker method was developed and validated for fast cardiac T(1) mapping in small animal models. By sampling the initial portion of the longitudinal magnetization recovery curve, high temporal resolution (∼ 3 min) can be achieved at a high spatial resolution (195 × 390 μm2) in mouse heart without the aid of parallel imaging or echo-planar imaging. Validation studies were performed both in vitro on a phantom and in vivo on C57BL/6 mice (n = 6). Our results showed a strong agreement between T(1) measured by saturation recovery Look-Locker and by the standard saturation recovery method in vitro or inversion recovery Look-Locker in vivo. The utility of saturation recovery Look-Locker in dynamic contrast-enhanced MRI studies was demonstrated in manganese-enhanced MRI experiments in mice. Our results suggest that saturation recovery Look-Locker can provide rapid and accurate cardiac T(1) mapping for studies using small animal models.
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Affiliation(s)
- Wen Li
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Coolen BF, Geelen T, Paulis LEM, Nauerth A, Nicolay K, Strijkers GJ. Three-dimensional T1 mapping of the mouse heart using variable flip angle steady-state MR imaging. NMR IN BIOMEDICINE 2011; 24:154-162. [PMID: 20960583 DOI: 10.1002/nbm.1566] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 04/20/2010] [Accepted: 04/20/2010] [Indexed: 05/28/2023]
Abstract
Cardiac MR T(1) mapping is a promising quantitative imaging tool for the diagnosis and evaluation of cardiomyopathy. Here, we present a new preclinical cardiac MRI method enabling three-dimensional T(1) mapping of the mouse heart. The method is based on a variable flip angle analysis of steady-state MR imaging data. A retrospectively triggered three-dimensional FLASH (fast low-angle shot) sequence (3D IntraGate) enables a constant repetition time and maintains steady-state conditions. 3D T(1) mapping of the complete mouse heart could be achieved in 20 min. High-quality, bright-blood T(1) maps were obtained with homogeneous T(1) values (1764 ± 172 ms) throughout the myocardium. The repeatability coefficient of R(1) (1/T(1) ) in a specific region of the mouse heart was between 0.14 and 0.20 s(-1) , depending on the number of flip angles. The feasibility for detecting regional differences in ΔR(1) was shown with pre- and post-contrast T(1) mapping in mice with surgically induced myocardial infarction, for which ΔR(1) values up to 0.83 s(-1) were found in the infarct zone. The sequence was also investigated in black-blood mode, which, interestingly, showed a strong decrease in the apparent mean T(1) of healthy myocardium (905 ± 110 ms). This study shows that 3D T(1) mapping in the mouse heart is feasible and can be used to monitor regional changes in myocardial T(1), particularly in relation to pathology and in contrast-enhanced experiments to estimate local concentrations of (targeted) contrast agent.
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Affiliation(s)
- Bram F Coolen
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Moriarty JM, Finn JP, Fonseca CG. Contrast agents used in cardiovascular magnetic resonance imaging: current issues and future directions. Am J Cardiovasc Drugs 2010; 10:227-37. [PMID: 20653329 DOI: 10.2165/11539370-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Cardiovascular MRI is being increasingly used in the evaluation of ischemic heart disease, cardiac masses, complex congenital heart disease, and morphologic evaluation of the vascular anatomy throughout the body. Many and varied contrast media may be used to increase the sensitivity and specificity of detecting and evaluating various pathologies, and a knowledge of the different mechanisms of action, distributions and safety profiles of these agents is required for safe and effective imaging. This article reviews the currently available magnetic resonance (MR) contrast media, discusses the risks and benefits, and gives illustrated examples of current clinical applications in cardiovascular disease. A literature search covered the period 1990 to the present with the use of multiple databases including MEDLINE, PUBMED, SciSearch and Google Medical. All identified studies containing information relevant to the topic of cardiovascular MRI and cardiovascular MR contrast agents and their uses and properties were evaluated. Evaluation was limited to studies in English. The conclusions were that the use of contrast agents vastly increases the diagnostic yield, sensitivity and specificity of cardiovascular MRI in the non-invasive diagnosis of the full breadth of cardiovascular pathology. The use of contrast MRI for investigating ischemic heart disease, cardiac masses, and congenital heart disease and in angiography is now well established, and the referring physician, cardiologist, or radiologist requires an in-depth knowledge of the safety profiles and correct dosing of commonly prescribed contrast agents. As the number of MR contrast agents on the market continues to increase, knowledge of the basic mechanism of action is vital for keeping abreast of how new and emerging agents will affect clinical practice in the future.
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Affiliation(s)
- John M Moriarty
- Diagnostic Cardiovascular Imaging, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Deegan CA, Griffin MJ. Clinical utility of intraoperative 2D and 3D transesophageal echocardiography in the assessment of a left atrial mass during pneumonectomy. J Cardiothorac Vasc Anesth 2010; 25:833-5. [PMID: 20864359 DOI: 10.1053/j.jvca.2010.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine A Deegan
- Department of Anesthesia and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin,
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Papini GDE, Tritella S, Secchi F, Aliprandi A, Di Leo G, Sardanelli F. Myocardial delayed enhancement using a single dose (0.1 mmol/kg) of gadobenate dimeglumine: contrast resolution versus intraventricular blood and viable myocardium. Radiol Med 2010; 115:693-701. [PMID: 20221713 DOI: 10.1007/s11547-010-0495-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 06/26/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE This study was done to estimate delayed enhancement (DE) contrast resolution of infarcted myocardium (IM) relative to intraventricular blood (IB) and viable myocardium (VM) using gadobenate dimeglumine (Gd-BOPTA). MATERIALS AND METHODS After approval from the Ethics Committee, we retrospectively evaluated 21 consecutive patients (61+/-10 years) with a healed myocardial infarction who underwent 1.5-T magnetic resonance (MR) imaging using an inversion-recovery-prepared turbo gradient-echo sequence 10 minutes after injection of 0.1 mmol/kg of Gd-BOPTA. Signal intensity (SI) was measured in arbitrary units (au) for IM, IB, VM, and outside the patient. Contrast-to-noise ratio (CNR) was calculated for IM to IB and IM to VM. Seven consecutive patients (59+/-6 years) with a healed myocardial infarction studied with similar technique but with 0.1 mmol/kg of gadoterate meglumine (Gd-DOTA) served as the control group. The Mann-Whitney U test was used to compare groups. RESULTS Mean SI of IM was 44+/-16 au for Gd-BOPTA and 20+/-6 au for Gd-DOTA (p<0.001), that of IB 35+/-15 au and 14+/-5 au (p=0.016), and that of VM 7+/-3 au and 5+/-2 au (p=0.116), respectively. Mean IM to IB CNR was 10+/-7 for Gd-BOPTA and 8+/-5 for Gd-DOTA (p=0.836), that of IM to VM was 45+/-27 and 18+/-6, respectively (p=0.012). CONCLUSIONS Gd-BOPTA at 0.1 mmol/kg produced a higher myocardial DE and an IM to VM CNR than a single dose of Gd-DOTA. No significant difference was observed for IM to IB CNR.
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Affiliation(s)
- G D E Papini
- Dipartimento di Scienze Medico-Chirurgiche, IRCCS Policlinico San Donato, Servizio di Radiologia, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milano, Italy
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Abstract
Coronary MR imaging is a promising noninvasive technique for the combined assessment of coronary artery anatomy and function. Anomalous coronary arteries and aneurysms can reliably be assessed in clinical practice using coronary MR imaging and the presence of significant left main or proximal multivessel coronary artery disease detected. Technical challenges that need to be addressed are further improvements in motion suppression and abbreviated scanning times aimed at improving spatial resolution and patient comfort. The development of new and specific contrast agents, high-field MR imaging with improved spatial resolution, and continued progress in MR imaging methods development will undoubtedly lead to further progress toward the noninvasive and comprehensive assessment of coronary atherosclerotic disease.
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Affiliation(s)
- Sebastian Kelle
- Division of Cardiology, Department of Medicine, German Heart Institute, Berlin, Germany; Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Left ventricular infarct size assessed with 0.1 mmol/kg of gadobenate dimeglumine correlates with that assessed with 0.2 mmol/kg of gadopentetate dimeglumine. J Comput Assist Tomogr 2009; 33:328-33. [PMID: 19478622 DOI: 10.1097/rct.0b013e318187fed0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine myocardial infarct (MI) size during cardiovascular magnetic resonance at 1.5 Tesla using 0.1 mmol/kg body weight of gadobenate dimeglumine (Gd-BOPTA) and 0.2 mmol/kg body weight of gadopentetate dimeglumine (Gd-DTPA). METHODS Twenty participants (16 men, 4 women), aged 58 +/- 12 years, with a prior chronic MI were imaged in a crossover design. Participants received 0.2 mmol/kg body weight of Gd-DTPA and 0.1 mmol/kg body weight of Gd-BOPTA on 2 occasions separated by 3 to 7 days. RESULTS The correlations were high between Gd-DTPA and Gd-BOPTA measures of infarct volume (r = 0.93) and the percentage of infarct relative to left ventricular myocardial volume (r = 0.85). The size and location of the infarcts were similar (P = 0.9) for the 2 contrast agents. Interobserver correlation of infarct volume (r = 0.91) was high. CONCLUSIONS In chronic MI, late gadolinium enhancement identified with a single 0.1 mmol/kg body weight dose of Gd-BOPTA is associated in volume and location to a double (0.2 mmol/kg body weight) dose of Gd-DTPA. Lower doses of higher relaxivity contrast agents should be considered for determining left ventricular myocardial infarct size.
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Snyder CJ, DelaBarre L, Metzger GJ, van de Moortele PF, Akgun C, Ugurbil K, Vaughan JT. Initial results of cardiac imaging at 7 Tesla. Magn Reson Med 2009; 61:517-24. [PMID: 19097233 DOI: 10.1002/mrm.21895] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This work reports preliminary results from the first human cardiac imaging at 7 Tesla (T). Images were acquired using an eight-channel transmission line (TEM) array together with local B(1) shimming. The TEM array consisted of anterior and posterior plates closely positioned to the subjects' thorax. The currents in the independent elements of these arrays were phased to promote constructive interference of the complex, short wavelength radio frequency field over the entire heart. Anatomic and functional images were acquired within a single breath hold to reduce respiratory motion artifacts while a vector cardiogram (VCG) was used to mitigate cardiac motion artifacts and gating. SAR exposure was modeled, monitored, and was limited to FDA guidelines for the human torso in subject studies. Preliminary results including short-axis and four-chamber VCG-retrogated FLASH cines, as well as, short-axis TSE images demonstrate the feasibility of safe and accurate human cardiac imaging at 7T.
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Affiliation(s)
- C J Snyder
- Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota 55455-3007, USA
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Free-Breathing MRI for the Assessment of Myocardial Infarction: Clinical Validation. AJR Am J Roentgenol 2009; 192:W277-81. [DOI: 10.2214/ajr.08.1580] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wong KKL, Kelso RM, Worthley SG, Sanders P, Mazumdar J, Abbott D. Noninvasive cardiac flow assessment using high speed magnetic resonance fluid motion tracking. PLoS One 2009; 4:e5688. [PMID: 19479033 PMCID: PMC2682657 DOI: 10.1371/journal.pone.0005688] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 04/22/2009] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular diseases can be diagnosed by assessing abnormal flow behavior in the heart. We introduce, for the first time, a magnetic resonance imaging-based diagnostic that produces sectional flow maps of cardiac chambers, and presents cardiac analysis based on the flow information. Using steady-state free precession magnetic resonance images of blood, we demonstrate intensity contrast between asynchronous and synchronous proton spins. Turbulent blood flow in cardiac chambers contains asynchronous blood proton spins whose concentration affects the signal intensities that are registered onto the magnetic resonance images. Application of intensity flow tracking based on their non-uniform signal concentrations provides a flow field map of the blood motion. We verify this theory in a patient with an atrial septal defect whose chamber blood flow vortices vary in speed of rotation before and after septal occlusion. Based on the measurement of cardiac flow vorticity in our implementation, we establish a relationship between atrial vorticity and septal defect. The developed system has the potential to be used as a prognostic and investigative tool for assessment of cardiac abnormalities, and can be exploited in parallel to examining myocardial defects using steady-state free precession magnetic resonance images of the heart.
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Affiliation(s)
- Kelvin Kian Loong Wong
- Centre for Biomedical Engineering and School of Electrical & Electronic Engineering, University of Adelaide, Adelaide, South Australia.
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Cardiac Flow Analysis Applied to Phase Contrast Magnetic Resonance Imaging of the Heart. Ann Biomed Eng 2009; 37:1495-515. [DOI: 10.1007/s10439-009-9709-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 04/28/2009] [Indexed: 01/05/2023]
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Turkbey EB, Dombroski DA. Cardiac Magnetic Resonance Imaging: Techniques and Clinical Applications. Semin Roentgenol 2009; 44:67-83. [PMID: 19233083 DOI: 10.1053/j.ro.2008.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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41
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Preim B, Oeltze S, Mlejnek M, Gröeller E, Hennemuth A, Behrens S. Survey of the visual exploration and analysis of perfusion data. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2009; 15:205-220. [PMID: 19147886 DOI: 10.1109/tvcg.2008.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Dynamic contrast-enhanced image data (perfusion data) are used to characterize regional tissue perfusion. Perfusion data consist of a sequence of images, acquired after a contrast agent bolus is applied. Perfusion data are used for diagnostic purposes in oncology, ischemic stroke assessment or myocardial ischemia. The diagnostic evaluation of perfusion data is challenging, since the data is complex and exhibits various artifacts, e.g., motion artifacts. We provide an overview on existing methods to analyze, and visualize CT and MR perfusion data. The integrated visualization of several 2D parameter maps, the 3D visualization of parameter volumes and exploration techniques are discussed. An essential aspect in the diagnosis of perfusion data is the correlation between perfusion data and derived time-intensity curves as well as with other image data, in particular with high resolution morphologic image data. We discuss visualization support with respect to the three major application areas: ischemic stroke diagnosis, breast tumor diagnosis and the diagnosis of coronary heart disease.
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Affiliation(s)
- Bernhard Preim
- Department of Simulation and Graphics, Faculty of Computer Science, University of Magdeburg, Magdeburg, Germany.
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A study of in vitro and in vivo MR of free-breathing whole-heart 3D coronary angiography using parallel imaging. Int J Cardiovasc Imaging 2009; 25 Suppl 1:121-9. [DOI: 10.1007/s10554-008-9415-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
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Cummings KW, Bhalla S, Javidan-Nejad C, Bierhals AJ, Gutierrez FR, Woodard PK. A Pattern-based Approach to Assessment of Delayed Enhancement in Nonischemic Cardiomyopathy at MR Imaging. Radiographics 2009; 29:89-103. [DOI: 10.1148/rg.291085052] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Danti M, Sbarbati S, Alsadi N, Di Filippo A, Gangitano G, Giglio L, Salvini V, Amoruso M, Camastra GS, Ansalone G, Della Sala S. Cardiac magnetic resonance imaging: diagnostic value and utility in the follow-up of patients with acute myocarditis mimicking myocardial infarction. Radiol Med 2008; 114:229-38. [PMID: 19082782 DOI: 10.1007/s11547-008-0353-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 02/27/2008] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of our study was to evaluate the efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between active myocarditis and myocardial infarction in patients with clinical symptoms mimicking acute myocardial infarction. MATERIALS AND METHODS Between 1 January 2006 and 30 June 2007, 23 consecutive patients (21 men and 2 women) presenting with electrocardiographic abnormalities mimicking acute myocardial infarction and a clinical suspicion of acute myocarditis (fever, chest pain and elevated troponin levels) underwent contrast-enhanced cardiac MRI within a week of admission. All patients also underwent coronary angiography, which demonstrated the absence of significant coronary artery lesions. The mean follow-up period was 2+/-4 months. RESULTS Cardiac MRI with injection of contrast material showed late subepicardial and intramyocardial enhancement in all patients. Subendocardial late enhancement, a typical pattern of myocardial infarction, was never seen. In addition, in agreement with the literature, there was prevalent involvement of the lateral segments of the left ventricular wall. CONCLUSIONS Cardiac MRI could be a valuable tool for the early diagnosis of acute myocarditis, as it can demonstrate specific patterns that help rule out acute myocardial infarction.
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Affiliation(s)
- M Danti
- U.O.C. di Radiodiagnostica, Ospedale M.G.Vannini, Via Dell'Acqua Bullicante 4, Roma, Italy.
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Jeudy J, White CS. Cardiac magnetic resonance imaging: techniques and principles. Semin Roentgenol 2008; 43:173-82. [PMID: 18486679 DOI: 10.1053/j.ro.2008.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jean Jeudy
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Müller S, Feuchtner G, Bonatti J, Müller L, Laufer G, Hiemetzberger R, Pachinger O, Barbieri V, Bartel T. Value of transesophageal 3D echocardiography as an adjunct to conventional 2D imaging in preoperative evaluation of cardiac masses. Echocardiography 2008; 25:624-31. [PMID: 18652008 DOI: 10.1111/j.1540-8175.2008.00664.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study sought to compare three-dimensional (3D) and two-dimensional (2D) transesophageal echocardiography (TEE) to assess intracardiac masses. It was hypothesized that 3D TEE would reveal incremental information for surgical and nonsurgical management. METHODS In 41 patients presenting with intracardiac masses (17 thrombi, 15 myxomas, 2 lymphomas, 2 caseous calcifications of the mitral valve and one each of hypernephroma, hepatocellular carcinoma, rhabdomyosarcoma, lipoma, and fibroelastoma), 2D and 3D TEE were performed, aiming to assess the surface characteristics of the lesions, their relationship to surrounding structures, and attachments. Diagnoses were made by histopathology (n = 28), by computed tomography (n = 8), or by magnetic resonance imaging (n = 5). Benefit was categorized as follows: (A) New information obtained through 3D TEE; (B) helpful unique views but no additional findings compared to 2D TEE; (C) results equivalent to 2D TEE; (D) 3D TEE missed 2D findings. RESULTS In 15 subjects (37%), 3D TEE revealed one or more items of additional information (category A) regarding type and site of attachment (n = 9, 22%), surface features (n = 6, 15%), and spatial relationship to surrounding structures (n = 8, 20%). In at least 18% of all intracardiac masses, 3D TEE can be expected to deliver supplementary information. In six patients, additional findings led to decisions deviating from those made on the basis of 2D TEE. In 11 subjects (27%), 3D echocardiographic findings were categorized as "B." CONCLUSIONS Information revealed by 3D imaging facilitates therapeutic decision making and especially the choice of an optimal surgical access prior to removal of intracardiac masses.
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Affiliation(s)
- Silvana Müller
- Cardiology Division, Department of Internal Medicine, University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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Hosch W, Kristen AV, Libicher M, Dengler TJ, Aulmann S, Heye T, Schnabel PA, Schirmacher P, Katus HA, Kauczor HU, Longerich T. Late enhancement in cardiac amyloidosis: correlation of MRI enhancement pattern with histopathological findings. Amyloid 2008; 15:196-204. [PMID: 18925458 DOI: 10.1080/13506120802193233] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Late enhancement (LE) in cardiac magnetic resonance imaging (MRI) is a characteristic finding in patients with cardiac amyloidosis (CA) but the histomorphological explanation has not been clarified yet. Five patients with CA were evaluated by MRI prior to heart transplantation. This consisted of morphological, volumetric, and functional data, including LE analysis. For LE analysis, left ventricular (LV) short-axis sections from basal, midventricular, and apical positions were divided into 12 segments resulting in a 36-segment model. Each segment was differentiated by subendocardial, midmural, and subepicardial localization. Histological amyloid and collagenous fiber deposition was correlated with LE in corresponding MRI slides. LE was visualized in 103/180 (57.2%) predominantly subendocardial segments. Histological analysis of amyloid deposition was (peri-)vascular (n = 5), diffuse interstitial (n = 3) and/or nodular (n = 4). Extent of fibrosis was moderate to severe. Cytoplasmatic vacuolization and decline of myofibrils was seen in all patients. Fibrosis was significantly associated with LE in subendocardial and midmural localizations (p<0.05), whereas the extent of amyloid deposition was not associated with LE findings in any region. LE seems to be associated with fibrosis due to ischemia of cardiomyocytes by small vessel amyloid deposition rather than with amyloid deposition in CA, suggesting that amyloid deposition might be present prior to LE detection.
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Affiliation(s)
- Waldemar Hosch
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany.
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Matoh F, Satoh H, Shiraki K, Odagiri K, Saitoh T, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis. J Cardiol 2008; 51:179-88. [PMID: 18522793 DOI: 10.1016/j.jjcc.2008.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 03/18/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Cardiac involvement is an important prognostic factor in patients with sarcoidosis. We evaluated the usefulness of delayed enhancement MRI (DE-MRI) for diagnosing cardiac sarcoidosis by comparing with nuclear imaging and studying the correlation between DE area and left ventricular (LV) function. METHODS Twelve patients (male:female 3:9) diagnosed as having sarcoidosis underwent Gd-MRI, myocardial perfusion SPECT (Tl-201, Tc-99m sestamibi), Ga-67 scintigraphy, and/or F-18 FDG-PET. RESULTS DE was observed in 5 patients, and was positive in 39 (39%) of 100 LV segments. The corresponding perfusion defects in myocardial perfusion SPECT were undetectable in 14 (36%) segments. DE distributed mainly in mid- to epi-myocardium, and the lack of perfusion defects in myocardial perfusion SPECT was more prominent in less transmural DE segments. Two patients with diffuse DE and 1 case with focal DE exhibited positive cardiac uptake in Ga-67 scintigraphy, and 2 other cases with focal DE showed cardiac uptake in F-18 FDG-PET. In 7 patients without DE, there were no significant findings in nuclear imaging. Both LV end-diastolic and end-systolic volume were positively and LV ejection fraction was negatively correlated with the extent of DE area. Four patients treated with corticosteroid showed improvement in nuclear imaging and slight decreases in DE area but no recovery in LV function. CONCLUSIONS DE-MRI is useful to diagnose the cardiac involvement of sarcoidosis and to evaluate cardiac function. It is likely that the distribution of DE in mid- to epi-myocardium is the characteristic of cardiac sarcoidosis, and the larger DE area may be correlated with poor LV function.
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Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan.
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Lindblade CL, Cohen MD, Hurwitz RA, Johnson TR. Delayed magnetic resonance imaging contrast enhancement of synthetic ventricular septum. CONGENIT HEART DIS 2008; 1:340-2. [PMID: 18377506 DOI: 10.1111/j.1747-0803.2006.00060.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is a report of a magnetic resonance imaging with delayed contrast enhancement on an adult patient with double-inlet left ventricle and L-transposition of the great arteries who has undergone staged ventricular septation in childhood. This report is unique demonstration of delayed contrast enhancement of the synthetic Teflon septum.
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Nael K, Fenchel M, Saleh R, Finn JP. Cardiac MR imaging: new advances and role of 3T. Magn Reson Imaging Clin N Am 2008; 15:291-300, v. [PMID: 17893050 DOI: 10.1016/j.mric.2007.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the last decade, cardiac magnetic resonance imaging has increasingly evolved into a useful diagnostic tool among the radiology and cardiology communities. Ongoing improvements in MR imaging hardware, processing speed, and pulse sequence development have laid the foundation for rapid progress in cardiac MR imaging. This article summarizes developing techniques and technique-related aspects, and the advantages and possible pitfalls of 3T in particular.
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Affiliation(s)
- Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 10945 Le Conte Avenue, Suite # 3371, Los Angeles, CA 90095-7206, USA.
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