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Vogt FM, Hunold P, Herborn CU, Ruehm SG, Barkhausen J, Kroger K. Combined arterial and venous whole-body MR angiography with cardiac MR imaging in patients with thromboembolic disease--initial experience. Eur Radiol 2008; 18:983-92. [PMID: 18193236 DOI: 10.1007/s00330-007-0832-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 10/23/2007] [Accepted: 11/26/2007] [Indexed: 10/22/2022]
Abstract
The objective was to assess the feasibility of a combined arterial and venous whole-body three-dimensional magnetic resonance (MR) angiography, together with a cardiac MR examination, in patients with arterial thromboembolism. Ten patients with arterial thromboembolism underwent a contrast-enhanced whole-body MR examination of the arterial and venous vessels, followed by a cardiac MR examination on a separate occasion within 24 h. All examinations were performed on a 1.5-T MR scanner. For both arterial and venous MR angiography only one injection of contrast agent was necessary. The cardiac imaging protocol included dark-blood-prepared half-Fourier acquisition single-shot turbo-spin-echo sequences, fast steady-state free precession cine sequences, T2-weighted turbo-spin-echo sequences and inversion recovery gradient-echo fast low-angle-shot sequences after injection of contrast agent. MR imaging revealed additional clinically unknown arterial thromboembolisms in four patients. The thoracic aorta was depicted as embolic source in four patients, while deep vein thrombosis (DVT) was found in one patient as the underlying disease. Unsuspected infarction of parenchymal organs was detected by MRI in two patients. An unknown additional DVT was found in one patient. Four patients were considered to have arterial emboli of cardiac origin. In conclusion, acquisition of arterial and venous MR angiograms of the entire vascular system combined with cardiac MR imaging is a most comprehensive and valuable strategy in patients with arterial thromboembolism.
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Affiliation(s)
- Florian M Vogt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Abstract
In this chapter, the basic principles of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) (Sects. 2.2, 2.3, and 2.4), the technical components of the MRI scanner (Sect. 2.5), and the basics of contrast agents and the application thereof (Sect. 2.6) are described. Furthermore, flow phenomena and MR angiography (Sect. 2.7) as well as diffusion and tensor imaging (Sect. 2.7) are elucidated.
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53
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Abstract
Superparamagnetic iron oxide (SPIO) contrast agents, clinically established for high resolution magnetic resonance imaging of reticuloendothelial system containing anatomical structures, can additionally be exploited for the non-invasive characterization and quantification of pathology down to the molecular level. In this context, SPIOs can be applied for non-invasive cell tracking, quantification of tissue perfusion and target specific imaging, as well as for the detection of gene expression. This article provides an overview of new applications for clinically approved iron oxides as well of new, modified SPIO contrast agents for parametric and molecular imaging.
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Affiliation(s)
- L Matuszewski
- Institut für Klinische Radiologie, Universitätsklinikum Münster.
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54
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Voskuyl AE. The heart and cardiovascular manifestations in rheumatoid arthritis. Rheumatology (Oxford) 2007; 45 Suppl 4:iv4-7. [PMID: 16980723 DOI: 10.1093/rheumatology/kel313] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular features in rheumatoid arthritis (RA) are common. Among those are the classical extra-articular features that not only include pericarditis, cardiomyopathy/myocarditis, cardiac amyloidosis, coronary vasculitis, arrhythmia and valve diseases, but also congestive heart failure and ischaemic heart disease which are found more frequently and are associated with an increased mortality compared with the general population. This overview discusses the epidemiological aspects of these cardiovascular diseases and their relevance for diagnosis and treatment of RA.
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Affiliation(s)
- A E Voskuyl
- Department of Rheumatology, 4-A-42, VU University Medical Center, POB 9057, 1007 MB Amsterdam, The Netherlands.
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55
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Dumont CA, Monserrat L, Soler R, Rodriguez E, Peteiro J, Fernández X, Rodríguez A, Pérez R, Bouzas B, Castro-Beiras A. Left Ventricular Asynchrony in Patients with Hypertrophic Cardiomyopathy: Its Determinants and its Relation to Left Ventricular Function. J Am Soc Echocardiogr 2007; 20:1247-52. [PMID: 17604956 DOI: 10.1016/j.echo.2007.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos A Dumont
- Division of Cardiology, Juan Canalejo Hospital, La Coruña, Spain
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56
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Abstract
Cardiovascular magnetic resonance imaging (MRI) has gained widespread acceptance for the assessment of cardiovascular disease. Cardiac MRI requires fast data acquisition schemes because of constraints imposed by physiological motion of cardiac structures and blood flow, which dictate the suitable window of data acquisition. The ongoing improvement of MRI hardware and the development of tailored imaging techniques have been the cornerstones for rapid progress in cardiac MRI. Cardiac MRI at 3.0 T holds the promise to overcome some of the signal-to-noise (SNR) limitations, especially for techniques with borderline SNR at 1.5 T (eg, myocardial perfusion, assessment of viability, or imaging of coronary arteries). The improved SNR at 3.0 T can be used to increase the spatial resolution and/or reduce imaging time. It was shown that all applications of cardiac imaging at 1.5 T seem feasible also at 3.0 T and predominantly provide similar or improved image quality. Although specific absorption rate limitations and susceptibility effects remain a primary concern, the combination of high-field strength examinations with parallel imaging has increased the performance of techniques such as steady-state free-precession at 3.0 T. Therefore, the signal-to-noise and the contrast-to-noise ratios advantages at 3.0 T and the resulting potential benefit for an improved diagnostic value will constantly fuel further developments in this area and pave the way for novel, promising imaging techniques.
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Affiliation(s)
- Michael Fenchel
- Department of Diagnostic Radiology, Eberhard-Karls University, Tuebingen, Germany.
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57
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Herborn CU, Watkins DM, Baumann S, Robert P, Corot C, Runge VM. Contrast-Enhanced Magnetic Resonance Angiography. Invest Radiol 2007; 42:622-8. [PMID: 17700277 DOI: 10.1097/rli.0b013e318059b58b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the gadolinium-based macromolecular intravascular contrast agent P792 for magnetic resonance angiography (MRA) at magnetic field strengths of 3.0 T, in comparison to 1.5 T, in rabbits. MATERIALS AND METHODS Eleven female New Zealand rabbits of the same age served as the animal model. Dose relationship testing was performed with 2 doses (13 and 25 micromol/kg; n = 4 per group) of P792 as compared with a single dose (100 micromol/kg; n = 3) of gadoterate meglumine (Gd-DOTA). All animals underwent contrast-enhanced MRA of the abdominal aorta and its branches on 2 occasions separated by 72 hours. The particular doses were administered in random order. Contrast-enhanced MRA was performed on 3.0 and 1.5 T whole-body MR systems, using a fast 3D spoiled gradient recalled echo sequence. Data acquisition was performed before and up to 10 minutes after administration of intravenous contrast material. Image quality was judged on a 4-point-Likert scale. Signal-to-noise and contrast-to-noise measurements were performed; statistical differences (P < 0.05) between the groups were determined. RESULTS P792 and Gd-DOTA yielded high-quality MR angiograms in rabbits in all cases. Although image quality within the first 3 minutes after contrast material administration was equal for both agents, P792 at a dose of 25 micromol/kg was considered superior to Gd-DOTA at the later time points. Signal-to-noise and contrast-to-noise values of the higher dose of P792 were statistically significantly higher than those of Gd-DOTA in the post-bolus phase. CONCLUSIONS P792 seems to be well suited for high-quality early phase and equilibrium phase MRA in rabbits at a field strength of 3.0 T, on the basis of this initial evaluation in an animal model.
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Affiliation(s)
- Christoph U Herborn
- Medical Prevention Center Hamburg (MPCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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58
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Borchert B, Lawrenz T, Bartelsmeier M, Röthemeyer S, Kuhn H, Stellbrink C. Utility of endomyocardial biopsy guided by delayed enhancement areas on magnetic resonance imaging in the diagnosis of cardiac sarcoidosis. Clin Res Cardiol 2007; 96:759-62. [PMID: 17694383 DOI: 10.1007/s00392-007-0557-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 05/28/2007] [Indexed: 10/23/2022]
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59
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Frullano L, Meade TJ. Multimodal MRI contrast agents. J Biol Inorg Chem 2007; 12:939-49. [PMID: 17659368 DOI: 10.1007/s00775-007-0265-3] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 05/10/2007] [Indexed: 02/04/2023]
Affiliation(s)
- Luca Frullano
- Department of Chemistry, Biochemistry and Molecular and Cell Biology, Neurobiology and Physiology, Radiology, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
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Matoh F, Satoh H, Shiraki K, Saitoh T, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Usefulness of delayed enhancement magnetic resonance imaging to differentiate dilated phase of hypertrophic cardiomyopathy and dilated cardiomyopathy. J Card Fail 2007; 13:372-9. [PMID: 17602984 DOI: 10.1016/j.cardfail.2007.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 02/02/2007] [Accepted: 02/05/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND The dilated phase of hypertrophic cardiomyopathy (HCM) has a poor prognosis. For correct recognition of such patients, we compared the findings in cardiac delayed enhancement (DE)-magnetic resonance imaging (MRI) between HCM and dilated cardiomyopathy (DCM) patients. METHODS AND RESULTS Sixty-five patients (HCM 39, DCM 26) underwent gadolinium-DTPA-enhanced MRI. The HCM patients were divided into those with preserved (HCM-P, n = 30) and those with impaired systolic function (HCM-I, n = 9). DE-MRI demonstrated focal or diffuse DE at the left ventricular (LV) wall in 60% of HCM-P and 100% of HCM-I, but in only 12% of DCM. The DE distributed mainly septal to the anterior wall of LV, but the DE volume against whole LV muscle volume was much larger in HCM-I than in HCM-P and DCM (4.1 +/- 6.1% in HCM-P, 14.6 +/- 11.9% in HCM-I, and 0.8 +/- 2.4% in DCM, means +/- SD, P < .05). In HCM, there were weak but significant correlations between DE volume, and LV end-diastolic volume and LV end-systolic volume. In HCM-P, the percent of length shortening in the segments with DE was lower than that without DE. CONCLUSIONS The HCM patients had more DE than the DCM patients, and DE volume correlated to lower global and local LV function. DE-MRI may be useful to evaluate myocardial damage in HCM patients, and to differentiate the dilated phase of HCM from DCM.
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Affiliation(s)
- Fumitaka Matoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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61
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Abstract
The tremendous progress in the field of cardiac imaging has drawn the interest of many radiologists, but has left them uncertain as to how obtain the training necessary to become expert practitioners. This review addresses the challenges in establishing a cardiac imaging service including equipment issues, training and credentialing issues, as well as referrals and reimbursement.
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Affiliation(s)
- John D Grizzard
- Department of Radiology, Virginia Commonwealth University Medical Center, Main Hospital, Richmond, Va 23298-0615 , USA.
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62
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Brodoefel H, Reimann A, Klumpp B, Fenchel M, Ohmer M, Miller S, Schroeder S, Claussen C, Scheule A, Kopp AF. Assessment of myocardial viability in a reperfused porcine model: evaluation of different MSCT contrast protocols in acute and subacute infarct stages in comparison with MRI. J Comput Assist Tomogr 2007; 31:290-8. [PMID: 17414768 DOI: 10.1097/01.rct.0000237806.57757.e6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess myocardial viability in acute and subacute infarcts using different multislice spiral computed tomography contrast protocols with magnetic resonance imaging (MRI) correlation. METHODS Seven pigs were studied with 64-multislice spiral computed tomography and MRI (1.5 T) at a median of 1 and 21 days after temporary occlusion of the second diagonal branch. Computed tomography was performed at 3, 5, 10, and 15 minutes after injection of contrast medium. Contrast agent was applied either as a bolus (protocol 1; n = 7 for the first; n = 5 for the second scan) or as a bolus plus 30 mL of subsequent 0.1 mL/s low-flow (protocol 2; n = 7 for the first; n = 6 for the second scan). Finally, histological sections were obtained. Volumes of infarcted myocardium were assessed as the percentage of the left ventricle. Computed tomography attenuation values were obtained, and image quality was assessed. RESULTS When compared with protocol 1, protocol 2 provided greater Hounsfield unit attenuation difference between viable and nonviable myocardium at 5, 10, and 15 minutes (P = 0.19; 0.003; 0.0006) and an additional significant contrast between nonviable myocardium and ventricular blood at 3 and 5 minutes (P < 0.001). Image quality was rated significantly higher with the use of protocol 2 at 5, 10, and 15 minutes (P < or = 0.027) and for all time points use of protocol 2 resulted in improved correlation of acute and subacute infarct size with MRI. CONCLUSIONS Good correlation of infarct zones with MRI was achieved for both acute and subacute infarcts. With the use of a bolus/low-flow protocol, image quality was substantially improved by means of a higher tissue contrast.
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Affiliation(s)
- Harald Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany.
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63
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Dumont CA, Monserrat L, Peteiro J, Soler R, Rodriguez E, Bouzas A, Fernández X, Pérez R, Bouzas B, Castro-Beiras A. Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy. Am J Cardiol 2007; 99:1454-7. [PMID: 17493479 DOI: 10.1016/j.amjcard.2006.12.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/20/2022]
Abstract
The degree of exercise capacity is poorly predicted by conventional markers of disease severity in patients with hypertrophic cardiomyopathy (HC). The principal mechanism of exercise intolerance in patients with HC is the failure of stroke volume augmentation due to left ventricular (LV) diastolic dysfunction. The role of LV chamber stiffness, assessed noninvasively, as a determinant of exercise tolerance is unknown. Sixty-four patients with HC were studied with Doppler echocardiography, exercise testing, and gadolinium cardiac magnetic resonance. The LV chamber stiffness index was determined as the ratio of pulmonary capillary wedge pressure (derived from the E/Ea ratio) to LV end-diastolic volume (assessed by cardiac magnetic resonance). Maximal exercise tolerance was defined as achieved METs. There were inverse correlations between METs achieved and age (r = -0.38, p = 0.003), heart rate deficit (r = -0.39, p = 0.002), LV outflow tract gradient (r = -0.33, p = 0.009), the E/Ea ratio (r = -0.4, p = 0.001), mean LV wall thickness (r = -0.26, p = 0.04), and LV stiffness (r = -0.56, p <0.001) and a positive correlation between METs achieved and LV end-diastolic volume (r = 0.33, p = 0.01). On multivariate analysis, only LV chamber stiffness was associated with exercise capacity. A LV stiffness level of 0.18 mm Hg/ml had 100% sensitivity and 75% specificity (area under the curve 0.84) for predicting < or =7 METs achieved. In conclusion, LV diastolic dysfunction at rest, as manifested by increased LV chamber stiffness, is a major determinant of maximal exercise capacity in patients with HC.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Analysis of Variance
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media
- Echocardiography, Doppler, Color
- Exercise Test
- Exercise Tolerance
- Female
- Gadolinium DTPA
- Heart Rate
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnosis
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Pulmonary Wedge Pressure
- Regression Analysis
- Research Design
- Rest
- Sensitivity and Specificity
- Severity of Illness Index
- Stroke Volume
- Vascular Resistance
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/physiopathology
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64
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Jackson E, Bellenger N, Seddon M, Harden S, Peebles C. Ischaemic and non-ischaemic cardiomyopathies—cardiac MRI appearances with delayed enhancement. Clin Radiol 2007; 62:395-403. [PMID: 17398263 DOI: 10.1016/j.crad.2006.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 11/09/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
Over the past few years, cardiovascular magnetic resonance (CMR) imaging has rapidly developed and is now a robust clinical tool capable of providing high-resolution images of the heart in any desired plane. Delayed contrast-enhanced CMR (DE-CMR) can be used for non-invasive tissue characterization, with differing patterns of hyperenhancement displayed by ischaemic and non-ischaemic cardiomyopathies. This review explains the theory behind delayed hyperenhancement, and demonstrates the potential of DE-CMR in the diagnosis of a wide range of different cardiac disease states.
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Affiliation(s)
- E Jackson
- Departments of Cardiothoracic Radiology, Southampton General Hospital, Tremona Road, Southampton, Hampshire, UK
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65
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Atalay MK. Establishing a cardiac MRI program: problems, pitfalls, expectations. J Am Coll Radiol 2007; 2:740-8. [PMID: 17411921 DOI: 10.1016/j.jacr.2005.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) has been used to evaluate the cardiovascular system for almost 2 decades. Although vascular applications have been robust and steadily improving for many years, the utility of MRI for clinical cardiac imaging has been limited. However, recent advances in hardware technology and pulse sequence design have led to substantial improvements in image quality, while reducing scan times to clinically reasonable durations. Pulse sequences using electrocardiographic gating and k-space segmentation have made it possible to obtain high-contrast, high-resolution images of the beating heart within single breath-holds. These images in turn have provided unprecedented visualization of myocardial morphology and function. Because of these developments, cardiac MRI (CMR) has made rapid and dramatic inroads into the clinical arena. Currently, the primary limitations to routine clinical application are hardware availability, clinical acceptance, politics, examination cost, and not least of all physician education. As these limitations are overcome or made more manageable, the clinical use of CMR will grow, potentially without bound. Combined with steady hardware development and an ever-growing armamentarium of pulse sequences, MRI may ultimately become the modality of choice for cardiac imaging. Because cardiac imaging is relatively unknown territory for most radiologists and because the high-end equipment has until now been sparsely available, CMR has been largely limited to major medical centers. However, if sufficient interest is present and resources are appropriately allocated, CMR can be successfully implemented in community imaging practices.
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Fieno DS, Thomson LEJ, Slomka P, Abidov A, Friedman JD, Germano G, Berman DS. Quantitation of infarct size in patients with chronic coronary artery disease using rest-redistribution Tl-201 myocardial perfusion SPECT: correlation with contrast-enhanced cardiac magnetic resonance. J Nucl Cardiol 2007; 14:59-67. [PMID: 17276307 DOI: 10.1016/j.nuclcard.2006.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 08/24/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rest and rest-redistribution thallium 201 myocardial perfusion single photon emission computed tomography (SPECT) (MPS) has been incompletely validated in patients for determination of the total amount of scarred myocardium. We sought to determine whether rest or redistribution Tl-201 MPS provides an accurate determination of infarct size as defined by delayed contrast-enhanced cardiac magnetic resonance (CMR). METHODS AND RESULTS We studied patients (n = 44) with chronic coronary artery disease referred for rest-redistribution Tl-201 MPS, who were also studied by contrast-enhanced CMR within 3 +/- 4 days. Patients were considered retrospectively based on a series of patients referred for clinically indicated MPS. Defect size, as a percent of left ventricular mass (% LV), was determined by quantitative perfusion SPECT (QPS) and compared with the volume of delayed hyperenhancement on contrast-enhanced CMR, normalized to LV mass. Infarct size varied from 0% to 43% LV. Rest QPS defect size correlated with the amount of nonviable myocardium assessed by contrast-enhanced CMR (r = 0.76; mean difference, 4.3% +/- 8.0% LV). When delayed thallium data were considered, redistribution QPS was superior to rest QPS for determination of infarct size (redistribution r = 0.90; mean difference, 2.4% +/- 5.2% LV; P = .03 vs rest). CONCLUSION Rest-redistribution Tl-201 MPS provides a more accurate measurement of total infarct size than rest-only Tl-201 MPS and correlates with contrast-enhanced CMR.
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Affiliation(s)
- David S Fieno
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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67
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Tanaka YO, Ohtsuka S, Shindo M, Oyake Y, Minami M. Comparison of delayed myocardial enhancement in the early and late phase after contrast injection: is it possible to reduce the examination time for myocardial viability study? Magn Reson Imaging 2007; 25:232-7. [PMID: 17275619 DOI: 10.1016/j.mri.2006.09.024] [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: 07/03/2006] [Accepted: 09/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We studied whether we can obtain a myocardial viability study immediately after contrast injection to reduce the whole cardiac MR examination time. MATERIALS AND METHODS We examined 36 patients with cardiovascular abnormality on comprehensive cardiac MRI. T1-weighted images with inversion recovery (IR) were obtained 5 min after stress perfusion with 0.05 mmol/kg of gadodiamide and 15 min after the resting perfusion with the same dose. (The latter images were obtained 25 min after the initial administration.) We evaluated the existence, the number of sectors, and the degree of enhancement at each time. The contrast ratio was also calculated. The number of the enhanced sectors and the contrast ratio were statistically compared using Student's t test. RESULTS All 17 cases of delayed myocardial enhancement at 25 min after contrast injection showed some enhancement at 5 min after contrast injection. However, the number of enhanced sectors was larger at 25 min after the initial injection in 11 cases, and it was statistically significant (P=.017). The degree of enhancement was stronger at 25 min in 14 cases. However, the contrast ratio at 5 and 25 min after contrast injection was not significantly different (P=.245). CONCLUSION Myocardial viability study immediately after contrast injection is too early to evaluate the extent of myocardial injury.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan.
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68
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Miguel-Dasit A, Martí-Bonmatí L, Sanfeliu P, Aleixandre R. Cardiac MR Imaging: Balanced Publication by Radiologists and Cardiologists. Radiology 2007; 242:410-6. [PMID: 17255412 DOI: 10.1148/radiol.2422060189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the number of articles on cardiac magnetic resonance (MR) imaging written by authors from radiology and cardiology departments and published in Medline-indexed journals from 1999 to 2004 and the relationship between the author's specialty and various parameters. MATERIALS AND METHODS Specific search profiles were devised to retrieve items from the Medline database. Eight hundred seven articles were included in the study. Relationships between the author's specialty (radiology or cardiology) and several evaluated parameters were analyzed and compared by using chi(2) statistics. RESULTS Four hundred eight (50.5%) of 807 publications were from cardiologists, and 399 (49.5%) of 807 were from radiologists. Articles most commonly originated from the United States (n = 270, 53% from radiologists) and Germany (n = 178, 66% from radiologists). Developing techniques (n = 248, 64% from radiologists, P < .001) was the most frequent topic. Results of clinical trials, controlled clinical trials, and randomized controlled trials were published mainly by cardiologists (67%, P = .03; 70%, P = .2; 86%, P = .008, respectively). A majority of articles were published in cardiology journals (n = 269, 83% from cardiologists, P < .001) and radiology journals (n = 249, 82% from radiologists, P < .001). CONCLUSION The number of publications on cardiac MR imaging written by radiologists and that written by cardiologists was essentially the same.
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69
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Abstract
Methods of noninvasive evaluation of coronary artery disease-including multidetector row computed tomography, electron beam computed tomography, magnetic resonance imaging, and nuclear studies (single photon emission computed tomography, positron emission tomography)-are reviewed.
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Affiliation(s)
- Gopi Kiran Reddy Sirineni
- Division of Cardiothoracic Imaging, Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322, USA
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70
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Cardiovascular Magnetic Resonance Imaging. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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71
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Dumont CA, Monserrat L, Soler R, Rodríguez E, Fernández X, Peteiro J, Bouzas B, Piñón P, Castro-Beiras A. Significado clínico del realce tardío de gadolinio con resonancia magnética en pacientes con miocardiopatía hipertrófica. Rev Esp Cardiol 2007. [DOI: 10.1157/13097921] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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72
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CT and MRI of Coronary Artery Disease:Self-Assessment Module. AJR Am J Roentgenol 2006. [DOI: 10.2214/ajr.06.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Recent developments in magnetic resonance (MR) imaging of the heart have refocused attention on the potential of MR and continue to attract intense interest within the radiology and cardiology communities. Improvements in speed, image quality, reliability, and range of applications have evolved to the point where cardiac MR imaging is increasingly seen as a practical clinical tool. As is often the case with MR imaging, not all of the most powerful techniques are necessarily easy to master or understand, and many-nonspecialists and specialists alike-are challenged to stay abreast. This review covers some of the major milestones that have led to the current state of cardiac MR and attempts to put into context some concepts that, although technical, have a real impact on the diagnostic power of cardiac MR imaging. Topics discussed include functional imaging, myocardial viability and perfusion imaging, flow quantification, and coronary artery imaging. A review such as this can only scratch the surface of what is a dynamic interdisciplinary field, but the hope is that sufficient information and insight are provided to stimulate the motivated reader to take his or her interest to the next level.
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Affiliation(s)
- J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 10945 Le Conte Ave, Suite 3371, Los Angeles, CA 90095-7206, USA.
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74
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Attili AK, Cascade PN. CT and MRI of coronary artery disease: evidence-based review. AJR Am J Roentgenol 2006; 187:S483-99. [PMID: 17114564 DOI: 10.2214/ajr.06.0309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The educational objective of this evidence-based self-assessment module is to use case examples to review the current evidence and the roles of CT and MRI in evaluating and managing patients with both congenital and acquired coronary artery disease. CONCLUSION In this educational module, we review the use of CT and MRI in the noninvasive diagnosis and management of patients with coronary artery disease.
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Affiliation(s)
- Anil K Attili
- Division of Cardiothoracic Radiology, Department of Radiology, Taubman Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0326, USA.
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75
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Vogel-Claussen J, Rochitte CE, Wu KC, Kamel IR, Foo TK, Lima JAC, Bluemke DA. Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics 2006; 26:795-810. [PMID: 16702455 DOI: 10.1148/rg.263055047] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of magnetic resonance (MR) imaging for diagnosis of cardiac diseases and treatment monitoring is expanding. Delayed myocardial enhancement MR imaging is performed after administration of paramagnetic contrast agents and is used for a growing number of clinical applications. This technique was developed primarily for characterization of myocardial scarring after myocardial infarction. On delayed enhancement MR images, scarring or fibrosis appears as an area of high signal intensity that is typically subendocardial or transmural in a coronary artery distribution. However, delayed myocardial enhancement is not specific for myocardial infarction and can occur in a variety of other disorders, such as inflammatory or infectious diseases of the myocardium, cardiomyopathy, cardiac neoplasms, and congenital or genetic cardiac conditions, as well as after cardiac interventions. In nonischemic myocardial disease, the delayed enhancement usually does not occur in a coronary artery distribution and is often midwall rather than subendocardial or transmural. Therefore, the patient's clinical history is critical in the evaluation of delayed myocardial enhancement MR images.
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Affiliation(s)
- Jens Vogel-Claussen
- Department of Radiology, Johns Hopkins Hospital, MRI, Room 143, 600 N Wolfe St, Baltimore, MD 21287, USA
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76
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Affiliation(s)
- Warren J Manning
- Beth Israel Deaconess Medical Center, Cardiovascular Division, Harvard Medical School, Boston, Massachusetts 02215, USA.
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77
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Woodard PK, Bluemke DA, Cascade PN, Finn JP, Stillman AE, Higgins CB, White RD, Yucel EK. ACR Practice Guideline for the Performance and Interpretation of Cardiac Magnetic Resonance Imaging (MRI). J Am Coll Radiol 2006; 3:665-76. [PMID: 17412147 DOI: 10.1016/j.jacr.2006.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) is an established imaging modality, recognized for its value in the assessment and monitoring of a wide range of cardiac pathology. It can provide physiologic as well as anatomic information. Image interpretation requires both well-developed MRI skills and knowledge of cardiac pathology. Radiologists, because of their extensive experience in MRI, have an important role in its application in the heart. The guidelines presented here are an educational tool designed to assist practitioners in providing the best possible patient care via the diagnostic methods of cardiac MRI. American College of Radiology requirements for physicians and personnel performing and interpreting cardiac MRI, which will become applicable by July 1, 2008, are also presented.
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Affiliation(s)
- Pamela K Woodard
- Mallinckrodt Institute of Radiology, Saint Louis, MO 63110, USA.
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78
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Abstract
The most common reason for heart failure in children is volume overload secondary to a left-to-right shunt. Therefore, an accurate diagnosis with identification of possible surgical or interventional reactions should be the first priority. Medical therapy is mainly based on diuretics, angiotensin-converting enzyme inhibitors, cardiac glycosides and beta-blockers. There are few prospective trials in pediatric cardiology, but the available data reach a similar conclusion to that of adults with heart failure. Diuretics are an important tool in patients with fluid retention, and angiotensin-converting enzyme inhibitors are helpful in patients with volume overload of the ventricles. Cardiac glycosides are still in use, but there is a trend toward primary use of diuretics. Angiotensin-converting enzyme inhibitors and beta-blockers have been used successfully in the treatment of heart failure in children, but there are limited data on its efficacy.
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79
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Tepe SM, Glockner JF. A Case of Acute Myocarditis with Evaluation of Magnetic Resonance Imaging. Int J Cardiovasc Imaging 2006; 23:233-5. [PMID: 16847738 DOI: 10.1007/s10554-006-9118-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 06/05/2006] [Indexed: 01/01/2023]
Abstract
A 42-year-old male with acute chest pain referred for acute myocarditis versus myocardial infarction (MI) was examined with magnetic resonance imaging (MRI). Clinical presentation and MRI findings are reviewed.
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Affiliation(s)
- Savas M Tepe
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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80
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Soler R, Rodríguez E, Monserrat L, Méndez C, Martínez C. Magnetic resonance imaging of delayed enhancement in hypertrophic cardiomyopathy: relationship with left ventricular perfusion and contractile function. J Comput Assist Tomogr 2006; 30:412-20. [PMID: 16778615 DOI: 10.1097/00004728-200605000-00011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to analyze the relationship between myocardial delayed enhancement, first-pass perfusion, and contractile function in hypertrophic cardiomyopathy (HCM) patients, using MR. METHODS Fifty-three patients diagnosed with HCM were prospectively examined using a 1.5-T MR unit. Multiphase gradient-echo sequences were performed to study global left ventricular function, wall thickness, and left ventricular mass. Myocardial tissue tagging was conducted to evaluate contractile function. T1-weighted inversion-recovery sequences were obtained at rest to study myocardial contrast enhancement at first pass and delayed enhancement 10 minutes later. RESULTS Delayed enhancement found in 30 patients (56.6%) was most commonly seen in hypertrophic segments. Nine patients exhibited delayed enhancement in segments with normal wall thickness (<15 mm). Sixteen patients (30.1%) showed first-pass perfusion defects at rest, which were associated with significantly lower stroke volume (P<0.05) and lower cardiac output (P<0.01). The hypokinetic segments found in 16 patients (30.1%) were significantly thicker at end diastole (P<0.01). Delayed enhancement correlated positively with perfusion defects (r=0.5, P<0.01) and hypokinetic segments (r=0.3, P<0.05). CONCLUSION Delayed myocardial enhancement is most commonly found in hypertrophic segments but also can be seen in segments with normal wall thickness. Perfusion defects at rest and impaired contractile function are related abnormalities with delayed myocardial enhancement. Further studies are necessary to assess the role of myocardial tagging, first-pass perfusion, and delayed enhancement in risk stratification for patients with HCM.
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Affiliation(s)
- Rafaela Soler
- Department of Radiology, Complejo Hospitalario Universitario Juan Canalejo, La Coruña, Spain.
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81
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Zaheer A, Raptopoulos V. Establishing a cardiac imaging rotation in radiology residency. Acad Radiol 2006; 13:871-3. [PMID: 16777561 DOI: 10.1016/j.acra.2006.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 01/09/2006] [Accepted: 02/09/2006] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVE The advent of new technologies for cardiac imaging such as magnetic resonance imaging (MRI) and cardiac computed tomography (CT) have added new tools in the armamentarium of noninvasive methods for predicting cardiac disease. However, training in cardiac anatomy and physiology is critical if radiology is to meet the demands of this service. MATERIALS AND METHODS We designed a core rotation in cardiac imaging at the Beth Israel Deaconess Medical Center, Harvard Medical School, to train residents in noninvasive cardiac imaging methods, such as cardiac echocardiography, nuclear cardiac imaging, cardiac MRI, and with special emphasis on cardiac CT. RESULTS This 1-month block includes cardiac imaging conferences and a lecture series, hands-on training in the use of imaging software, introduction to cardiac catheterization, and clinical cardiology. Residents are provided with a set of research and review articles along with textbooks on coronary imaging to serve as references for this rotation. CONCLUSION We believe that this educational exercise will establish a core of young, knowledgeable, and capable physicians who will be able to meet the clinical demand for noninvasive cardiac imaging and maintain a major role in this emerging specialty.
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Affiliation(s)
- Atif Zaheer
- Department of Radiology, Beth Israel Deaconess Medical Center, 350 Brookline Avenue, Boston, MA 02215, USA.
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82
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Mandapaka S, D'Agostino R, Hundley WG. Does late gadolinium enhancement predict cardiac events in patients with ischemic cardiomyopathy? Circulation 2006; 113:2676-8. [PMID: 16769923 DOI: 10.1161/circulationaha.106.631432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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83
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Brodoefel H, Klumpp B, Reimann A, Ohmer M, Fenchel M, Schroeder S, Miller S, Claussen C, Kopp AF, Scheule AM. Late myocardial enhancement assessed by 64-MSCT in reperfused porcine myocardial infarction: diagnostic accuracy of low-dose CT protocols in comparison with magnetic resonance imaging. Eur Radiol 2006; 17:475-83. [PMID: 16802125 DOI: 10.1007/s00330-006-0334-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 04/23/2006] [Accepted: 05/08/2006] [Indexed: 02/06/2023]
Abstract
The purpose was to assess the practicability of low-dose CT imaging of late enhancement in acute infarction. Following temporary occlusion of the second diagonal branch, seven pigs were studied by multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). Thus, 64-slice CT was performed at 3, 5, 10 and 15 min following the injection of contrast medium according to a bolus/low-flow protocol. Standard parameters of 120 kV and 800 mAs were compared with 80 kV and 400 mAs in various combinations. Infarct volumes were assessed as percentage of the ventricle for both MSCT and MR images. CT density values for viable and infarcted myocardium were obtained and image quality assessed. Mean infarct volume as measured by MRI was 12.33+/-7.06%. MSCT achieved best correlation of volumes at 5 and 10 min. Whilst lowering of tube current resulted in poor correlation, tube voltage did not affect accuracy of infarct measurement (r (2)=0.92 or 0.93 at 5 min, 800 mAs and 80 or 120 kV). In terms of image quality, greater image noise with 80 kV was compensated by significantly better contrast enhancement between viable and non-viable myocardium at lower voltage. Myocardial viability can accurately be assessed by MSCT at 80 kV, which ensures higher contrast for late enhancement and yields good correlation with MRI.
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Affiliation(s)
- H Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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84
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Bernardes RJM, Marchiori E, Bernardes PMDB, Monzo Gonzaga MBA, Simões LC. A comparison of magnetic resonance angiography with conventional angiography in the diagnosis of tetralogy of Fallot. Cardiol Young 2006; 16:281-8. [PMID: 16725068 DOI: 10.1017/s1047951106000370] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2005] [Indexed: 11/06/2022]
Abstract
AIMS Our purpose was to assess the value of magnetic resonance angiography as a non-invasive alternative to catheterization in the evaluation of patients with tetralogy of Fallot, including those with pulmonary atresia. METHODS AND RESULTS We evaluated prospectively, using magnetic resonance angiography, 30 patients, aged from 1 to 18 years, 15 with tetralogy of Fallot and pulmonary stenosis, and 15 with pulmonary atresia. The studies obtained using magnetic resonance provided adequate visualization of the aorta, and provided excellent imaging of the pulmonary trunk and its right and left branches. Compared with catheterization, magnetic resonance had 100 percent sensitivity, specificity and accuracy for defining the presence or absence of the pulmonary arteries. Magnetic resonance also had 93.9 percent sensitivity, 98.2 percent specificity, and 96.7 percent accuracy for detection of stenosis or hypoplasia of the pulmonary arteries. We detected 25 major aortopulmonary collateral arteries with magnetic resonance, but only 22 with conventional angiography. There was complete agreement between the two methods in detecting patency of the arterial duct in 6 patients, and of Blalock-Taussig shunts in 12 patients. CONCLUSION Magnetic resonance angiography is a useful tool in the evaluation of patients with tetralogy of Fallot. It can be considered a non-invasive alternative to cardiac catheterization in the evaluation of the pulmonary vascular anatomy.
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85
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Niendorf T, Sodickson DK. Parallel imaging in cardiovascular MRI: methods and applications. NMR IN BIOMEDICINE 2006; 19:325-41. [PMID: 16705633 DOI: 10.1002/nbm.1051] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cardiovascular MR imaging (CVMR) has become a valuable modality for the non-invasive detection and characterization of cardiovascular diseases. CVMR requires high imaging speed and efficiency, which is fundamentally limited in conventional cardiovascular MRI studies. With the introduction of parallel imaging, alternative means for increasing acquisition speed beyond these limits have become available. In parallel imaging some image data are acquired simultaneously, using RF detector coil sensitivities to encode simultaneous spatial information that complements the information gleaned from sequential application of magnetic field gradients. The resulting improvements in imaging speed can be used in various ways, including shortening long examinations, improving spatial resolution and/or anatomic coverage, improving temporal resolution, enhancing image quality, overcoming physiological constraints, detecting and correcting for physiologic motion, and streamlining work flow. Examples of each of these strategies will be provided in this review. First, basic principles and key concepts of parallel MR are described. Second, practical considerations such as coil array design, coil sensitivity calibrations, customized pulse sequences and tailored imaging parameters are outlined. Next, cardiovascular applications of parallel MR are reviewed, ranging from cardiac anatomical and functional assessment to myocardial perfusion and viability to MR angiography of the coronary arteries and the large vessels. Finally, current trends and future directions in parallel CVMR are considered.
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Affiliation(s)
- Thoralf Niendorf
- Department of Diagnostic Radiology, University Hospital, RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
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86
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Kim DH, Choi SI, Chang HJ, Choi DJ, Lim C, Park JH. Delayed Hyperenhancement by Contrast-Enhanced Magnetic Resonance Imaging. J Comput Assist Tomogr 2006; 30:226-32. [PMID: 16628037 DOI: 10.1097/00004728-200603000-00011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical applications of contrast-enhanced magnetic resonance (MR) imaging for defining viability are evolving as a result of the advantage of the technique's excellent spatial resolution. The value of delayed hyperenhancement imaging is for the accurate identification of the infarcted myocardium with resolution that allows determination of the transmural extent of myocardial injury. In addition, nonischemic patterns of myocardial injury such as dilated or hypertrophic cardiomyopathy have been reported in other disease states. Delayed hyperenhancement may have an additional role in guiding the management of or determining the prognosis for diseases such as myocarditis. In this study, the clinical application of delayed hyperenhancement is demonstrated for various cardiac diseases such as myocardial infarction, including right ventricular infarction; microvascular obstruction; and nonischemic cardiomyopathy such as dilated cardiomyopathy and myocarditis.
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Affiliation(s)
- Dong Hun Kim
- Department of Radiology, Chosun University Hospital, Gwangju, Korea
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87
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Thorek DLJ, Chen AK, Czupryna J, Tsourkas A. Superparamagnetic Iron Oxide Nanoparticle Probes for Molecular Imaging. Ann Biomed Eng 2006; 34:23-38. [PMID: 16496086 DOI: 10.1007/s10439-005-9002-7] [Citation(s) in RCA: 592] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 09/12/2005] [Indexed: 01/11/2023]
Abstract
The field of molecular imaging has recently seen rapid advances in the development of novel contrast agents and the implementation of insightful approaches to monitor biological processes non-invasively. In particular, superparamagnetic iron oxide nanoparticles (SPIO) have demonstrated their utility as an important tool for enhancing magnetic resonance contrast, allowing researchers to monitor not only anatomical changes, but physiological and molecular changes as well. Applications have ranged from detecting inflammatory diseases via the accumulation of non-targeted SPIO in infiltrating macrophages to the specific identification of cell surface markers expressed on tumors. In this article, we attempt to illustrate the broad utility of SPIO in molecular imaging, including some of the recent developments, such as the transformation of SPIO into an activatable probe termed the magnetic relaxation switch.
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Affiliation(s)
- Daniel L J Thorek
- Cellular and Molecular Imaging Group, Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
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88
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Carette MF, Kerrou K, Khalil A. [Functional chest imaging]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:291-5. [PMID: 16292153 DOI: 10.1016/s0761-8417(05)84842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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89
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Tanaka YO, Ohtsuka S, Shindo M, Katsumata Y, Oyake Y, Minami M. Efficacy of spectral presaturation of inversion recovery in evaluating delayed myocardial enhancement. Magn Reson Imaging 2005; 23:893-7. [PMID: 16275429 DOI: 10.1016/j.mri.2005.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 07/07/2005] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Delayed myocardial enhancement is caused by a variety of cardiovascular diseases. The extent of the enhanced area has been examined by the inversion recovery (IR) method, whereby at the inversion time (TI), normal myocardium shows a low signal intensity. In this sequence, as pericardial fat shows a very high intensity, a delayed enhancement just below the pericardium may be indistinct. To improve the accuracy of delayed myocardial enhancement, we employed the spectral presaturation of inversion recovery (SPIR) method. MATERIALS AND METHODS Thirty-five patients with symptoms of cardiovascular disease aged between 36 and 80 years old (mean age, 62 years old) were investigated. Thirty were men and five were women. Inversion recovery and SPIR images were obtained 25 min after initial administration of a gadolinium-based contrast material. Each TI, when the signal intensity of the normal myocardium was null, was determined by images obtained at serial different TIs. A radiologist and a cardiologist examined each image by a consensus reading. The extent of myocardial enhancement was described as none, subendocardial, transmural and a random pattern in each case. Images were ranked over three levels and were based on whether myocardial enhancement could be easily detected or whether the contour of the myocardium was visualized precisely. Student's t-test was conducted to compare the quality of two sequences in all patients and in 22 patients who showed delayed myocardial enhancement. RESULTS The imaging quality in evaluating delayed myocardial enhancement in all patients was superior with IR compared with SPIR, although it was not statistically significant. The imaging quality in the patients with delayed myocardial enhancement was similar between SPIR and IR. SPIR was superior to the IR sequence in two of the four patients who exhibited transmural enhancement. CONCLUSION SPIR exhibited equivalent image quality to IR in evaluating delayed myocardial enhancement. As it has the potential advantage in patients with rich adipose tissue surrounding the myocardium, it can be an alternative sequence to evaluate myocardial viability.
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Affiliation(s)
- Yumiko Oishi Tanaka
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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90
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Canter CE. Therapy for pediatric myocarditis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2005; 7:411-7. [PMID: 16138960 DOI: 10.1007/s11936-005-0025-z] [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: 10/23/2022]
Abstract
Pediatric myocarditis is most often associated with the acute or subacute onset of congestive heart failure in a previously healthy child. Myocarditis presenting with acute, severe symptomatology, termed fulminant myocarditis, has a high rate of recovery. Aggressive supportive care is indicated in fulminant myocarditis, including mechanical circulatory support. For subacute heart failure, supportive care remains the mainstay of therapy for myocarditis. A number of uncontrolled pediatric studies using both immunosuppressive therapy and/or immunomodulating therapy with intravenous gamma globulin have suggested these therapies are safe and useful in treating pediatric myocarditis. However, translating these results into recommended, routine therapy for pediatric myocarditis is complicated by the high rate of spontaneous improvement of myocarditis with supportive care, and the lack of demonstrable benefit for immunosuppressive and immunomodulating therapies in blinded, randomized, placebo-controlled trials in adult myocarditis. Heart transplantation remains the final therapeutic option for children with myocarditis and intractable severe heart failure.
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Affiliation(s)
- Charles E Canter
- Department of Pediatrics, Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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