Cardiac Magnetic Resonance Features Research Articles

Value of CMR for the Differential Diagnosis of Cardiac Masses

ObjectivesThe goal of this study was to evaluate the diagnostic value of CMR features for the differential diagnosis of cardiac masses. BackgroundDifferentiation of cardiac tumors and thrombi and differentiation of benign from malignant cardiac neoplasms is often challenging but important in clinical practice. Studies assessing the value of cardiac magnetic resonance (CMR) in this regard are scarce. MethodsWe reviewed the CMR scans of patients with a definite cardiac thrombus or tumor. Mass characteristics on cine, T1-weighted turbo spin echo (T1w-TSE) and T2-weighted turbo spin echo (T2w-TSE), contrast first-pass perfusion (FPP), post-contrast inversion time (TI) scout, and late gadolinium enhancement (LGE) sequences were analyzed. ResultsThere were 84 thrombi, 17 benign tumors, and 25 malignant tumors in 116 patients. Morphologically, thrombi were smaller (median area 1.6 vs. 8.5 cm2; p < 0.0001), more homogeneous (99% vs. 46%; p < 0.0001), and less mobile (13% vs. 33%; p = 0.007) than tumors. Hyperintensity compared with normal myocardium on T2w-TSE, FPP, and LGE were more common in tumors than in thrombi (85% vs. 42%, 70% vs. 4%, and 71% vs. 5%, respectively; all p < 0.0001). A pattern of hyperintensity/isointensity (compared with normal myocardium) with short TI and hypointensity with long TI was very frequent in thrombi (94%), rare in tumors (2%), and had the highest accuracy (95%) for the differentiation of both entities. Regarding the characterization of neoplastic masses, malignant tumors were larger (median area 11.9 vs. 6.3 cm2; p = 0.006) and more frequently exhibited FPP (84% vs. 47%; p = 0.03) and LGE (92% vs. 41%; p = 0.001). The ability of CMR features to distinguish benign from malignant neoplasms was moderate, with LGE showing the highest accuracy (79%). ConclusionsCMR features demonstrated excellent accuracy for the differentiation of cardiac thrombi from tumors and can be helpful for the distinction of benign versus malignant neoplasms.

Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis, clinical features and prognosis.

The recent development of cardiac magnetic resonance (CMR) techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution. We review characteristic CMR features in ischemic and non-ischemic cardiomyopathies (ICM and NICM), especially in terms of the location and distribution of late gadolinium enhancement (LGE). CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the subendocardial or transmural LGE. LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function, including dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy (HCM), cardiac sarcoidosis, and myocarditis, and those with diffuse left ventricular (LV) hypertrophy including HCM, cardiac amyloidosis and Anderson-Fabry disease. A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy. In arrhythmogenic right ventricular cardiomyopathy/dysplasia, an enhancement of right ventricular (RV) wall with functional and morphological changes of RV becomes apparent. Finally, the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments.

Circulation: Cardiovascular Interventions Editors’ Picks

<i>Circulation: Cardiovascular Interventions</i> Editors’ Picks

Predictive value of cardiac magnetic resonance for the diagnosis and surgical relief of pericardial constriction

Background The diagnosis of pericardial constriction (PC) remains challenging and cardiac magnetic resonance (CMR) is increasingly used as a diagnostic tool. The objective of this study was to evaluate CMR findings for the prediction of subsequent surgical pericardiectomy. Methods CMR studies of 36 patients referred to assess for PC were evaluated retrospectively. Patients were divided into two groups depending on whether they subsequently had their pericardium stripped (n=18) or did not (n=18). IVC and aortic areas were determined by manual contouring on a single axial-SSFP image in maximum systole at the level of the esophageal hiatus. The ratio of IVC to aortic (I:A) area was calculated. Cross-sectional areas were indexed to body surface area (BSA). Quantitative data was assessed with a two-sample t-test and qualitative data was assessed with Fisher’s exact test. A logistic regression model was used to determine the predictive probability of surgical pericardiectomy based on CMR features. Odds ratios (ORs) were calculated and receiver operating characteristic (ROC) analysis was performed. Results Mean age of patients was 53.9±15.3 years, 72% (n=26) male, with no significant difference in mean age between the two groups (p=0.429). In patients with constriction, the underlying etiology was idiopathic (39%, n=7), infectious (28%, n=5), post-surgical (17%, n=3), connective-tissue disease (11%, n=2), and post-radiation (6%, n=1). IVC area, indexed IVC area, I:A ratio, pericardial thickness, RV area and indexed RV area were significantly different in patients who underwent pericardiectomy compared to those who did not (Table 1). Pericardiectomy was significantly associated with pericardial enhancement (p=0.011) as well as septal bounce (p<0.0001). The odds ratio (OR) for undergoing pericardiectomy in patients with septal bounce was 289 (95% confidence interval (CI) (16.681, 5007). Using ROC analysis, the area under the curve (AUC) and 95% CI for the prediction of pericardiectomy was 0.968 (0.92, 1.00) for IVC area, 0.932 (0.86, 1.00) for indexed IVC area and 0.963 (0.91, 1.00) for I:A ratio (Figure 1). An IVC area of 7.0 cm 2 had 92% accuracy (sensitivity=94%, specificity=89%), an indexed IVC area of 3.4 cm 2 /m 2 had 86% accuracy (sensitivity=94%, specificity=78%) and a I:A ratio of 1.8 had 92% accuracy (sensitivity=89%, specificity=94%). Conclusions

Diagnosis and Management of Cardiomyopathies – A Focus on Genetics, Cardiac Magnetic Resonance and Clinical Features

In recent years, outstanding progress has been made in the diagnosis and treatment of cardiomyopathies. Genetics is emerging as a primary point in the diagnosis and management of these diseases. However, molecular genetic analyses are not yet included in routine clinical practice, mainly because of their elevated costs and execution time. A patient-based and patient-oriented clinical approach, coupled with new imaging techniques such as cardiac magnetic resonance, can be of great help in selecting patients for molecular genetic analysis and is crucial for a better characterisation of these diseases. This article will specifically address clinical, magnetic resonance and genetic aspects of the diagnosis and management of cardiomyopathies.

Early Postoperative Tako-Tsubo-Like Left Ventricular Dysfunction: Transient Left Ventricular Apical Ballooning Syndrome

We diagnosed transient left ventricular apical wall motion abnormalities after surgery in a patient presenting with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. These angiographic, clinical, and electrocardiographic features satisfied the criteria of the recently described tako-tsubo-like left ventricular dysfunction.