ASSESSMENT OF LATE GADOLINIUM ENHANCEMENT IN CARDIAC MRI
Abstract
The aim of this study was to evaluate MRI characteristics of ischemic and non-ischemic cardiomyopathies with late dadolinium enhancement analysis that can provide differentiation between these two cardiomyopathies. Eligible 96 patients, age range from 26 to 71 years, who showed different and overlapping clinical symptoms, ECG andtransthoracic echocardiography findings that needed further evaluation were included in our study for further evaluation with cardiac MRI. Of the evaluated patients, 47 were females and 49 were males. The examinations were performed with MRI Scanner 1,5T Siemens Avanto by using 3 channeledSiemens ECG electrodes with retrospective triggering. With the help of PSIR sequence for late gadolinium enhancement evaluation we differentiated ischemic cardiomyopathy from non-ischemic cardiomyopathy, which is crucial for management of patients with cardiac dysfunction. Of the examined 96 patients, 42 patients were diagnosed with ischemic cardiomyopathy, 51 with non-ischemic cardiomyopathy, and 3 patients had non-conclusive diagnosis. It was found that late gadolinium images in the setting of cardiac MRI were capable of detecting myocardial scars and fibrosis. Moreover, they helped in differentiation between ischemic and non-ischemic cardiomyopathieson the basis of myocardial scar enhancement pattern.
Keywords: cardiac magnetic resonance, late gadolinium enhancement, cardiac function, prognosis
https://doi.org/10.55302/JMS2142163hn
References
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patients with ischemic cardiomyopathy? Circulation. 2006;113(23):2676–8.
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Utility in myocardial assessment. Radiographics. 2006;26(3):795–810.
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25. Naruse Y, Sato A, Kasahara K, Makino K, Sano M, Takeuchi Y, et al. The clinical impact of late gadolinium
enhancement in Takotsubo cardiomyopathy: Serial analysis of cardiovascular magnetic resonance images. J
Cardiovasc Magn Reson. 2011;13(1):1–9.
26. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, et al. Transient left ventricular apical
ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction.
J Am Coll Cardiol. 2001;38(1):11–8.
27. Wittstein IS, Thiemann DR, Lima JAC, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral
Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med. 2005;352(6):539–48.
28. Maréchaux S, Fornes P, Petit S, Poisson C, Thevenin D, Le Tourneau T, et al. Pathology of inverted Takotsubo
cardiomyopathy. Cardiovasc Pathol. 2008;17(4):241–3.
29. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural History and
Expansive Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy. J Am Coll Cardiol [Internet].
2010;55(4):333–41. Available from: http://dx.doi.org/10.1016/j.jacc.2009.08.057
30. Leurent G, Larralde A, Boulmier D, Fougerou C, Langella B, Ollivier R, et al. Cardiac MRI studies of transient
left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): A systematic review. Int J Cardiol
[Internet]. 2009;135(2):146–9. Available from: http://dx.doi.org/10.1016/j.ijcard.2009.03.067
31. Al-Mallah MH, Shareef MN. The role of cardiac magnetic resonance imaging in the assessment of non-
ischemic cardiomyopathy. Heart Fail Rev. 2011;16(4):369–80.
32. Yelgec SN, Dymarkowski S, Ganame J, Bogaert J. Value of MRI in patients with a clinical suspicion of acute
myocarditis. Eur Radiol. 2007;17(9):2211–7.
33. Zagrosek A, Wassmuth R, Abdel-Aty H, Rudolph A, Dietz R, Schulz-Menger J. Relation between myocardial
edema and myocardial mass during the acute and convalescent phase of myocarditis - A CMR study. J
Cardiovasc Magn Reson. 2008;10(1):1–8.
34. Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Ntusi N, et al. T1 Mapping for the
diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced
imaging. JACC Cardiovasc Imaging. 2013;6(10):1048–58.
35. Assomull RG, Lyne JC, Keenan N, Gulati A, Bunce NH, Davies SW, et al. The role of cardiovascular magnetic
resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur
Heart J. 2007;28(10):1242–9.
36. Sanghvi SK, Schwarzman LS, Nazir NT. Cardiac MRI and Myocardial Injury in COVID-19: Diagnosis, Risk
Stratification and Prognosis. Diagnostics. 2021;11(1):130.
Radiol Case Rep. 2015;9(6):6–18.
2. Saeed M, Wagner S, Wendland MF, Derugin N, Finkbeiner WE, Higgins CB. Occlusion and reperfused.
Radiology. 1989;172:59–64.
3. Dulce MC, Duerinckx AJ, Hartiala J, Caputo GR, O’Sullivan M, Cheitlin MD, et al. MR imaging of the myocardium
using nonionic contrast medium: Signal- intensity changes in patients with subacute myocardial infarction. Am
J Roentgenol. 1993;160(5):963–70.
4. Gerber BL, Garot J, Bluemke DA, Wu KC, Lima JAC. Accuracy of contrast-enhanced magnetic resonance imaging
in predicting improvement of regional myocardial function in patients after acute myocardial infarction.
Circulation. 2002;106(9):1083–9.
5. Satoh H. Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in
differential diagnosis, clinical features and prognosis. World J Cardiol. 2014;6(7):585.
6. As- NYH. Contrast-enhanced magetic resonance imaging to identify reversibke myocardial dysfunction.
2000;1445–53.
7. Ibrahim HR, Housseini AM, Khalil TH, Allam KE, Ali HH. Role of cardiac MRI in assessment of patients with
dilated cardiomyopathy. Egypt J Radiol Nucl Med [Internet]. 2017;48(4):853–60. Available from:
https://doi.org/10.1016/j.ejrnm.2017.04.008
8. Valle-Muñoz A, Estornell-Erill J, Soriano-Navarro CJ, Nadal-Barange M, Martinez-Alzamora N, Pomar-Domingo
F, et al. Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease
as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure. Eur J Echocardiogr.
2009;10(8):968–74.
9. Mandapaka S, D’Agostino R, Hundley WG. Does late gadolinium enhancement predict cardiac events in
patients with ischemic cardiomyopathy? Circulation. 2006;113(23):2676–8.
10. Vogel-Claussen J, Rochitte CE, Wu KC, Kamel IR, Foo TK, Lima JAC, et al. Delayed enhancement MR imaging:
Utility in myocardial assessment. Radiographics. 2006;26(3):795–810.
11. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and
classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council
on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes
Research and Functio. Circulation. 2006;113(14):1807–16.
12. Matoh F, Satoh H, Shiraki K, Saitoh T, Urushida T, Katoh H, et al. Usefulness of Delayed Enhancement
Magnetic Resonance Imaging to Differentiate Dilated Phase of Hypertrophic Cardiomyopathy and Dilated
Cardiomyopathy. J Card Fail. 2007;13(5):372–9.
13. McCrohon JA, Moon JCC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJS, et al. Differentiation of heart failure
related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular
magnetic resonance. Circulation. 2003;108(1):54–9.
14. Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, et al. Equilibrium contrast
cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: Preliminary
validation in humans. Circulation. 2010;122(2):138–44.
15. Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, et al. Cardiovascular Magnetic Resonance,
Fibrosis, and Prognosis in Dilated Cardiomyopathy. J Am Coll Cardiol. 2006;48(10):1977–85.
16. Shimizu I, Iguchi N, Watanabe H, Umemura J, Tobaru T, Asano R, et al. Delayed enhancement cardiovascular
magnetic resonance as a novel technique to predict cardiac events in dilated cardiomyopathy patients. Int J
Cardiol [Internet]. 2010;142(3):224–9. Available from: http://dx.doi.org/10.1016/j.ijcard.2008.12.189
17. Lehrke S, Lossnitzer D, Schöb M, Steen H, Merten C, Kemmling H, et al. Use of cardiovascular magnetic
resonance for risk stratification in chronic heart failure: Prognostic value of late gadolinium enhancement in
patients with non-ischaemic dilated cardiomyopathy. Heart. 2011;97(9):727–32.
18. Satoh H, Matoh F, Shiraki K, Saitoh T, Odagiri K, Saotome M, et al. Delayed Enhancement on Cardiac
Magnetic Resonance and Clinical, Morphological, and Electrocardiographical Features in Hypertrophic
Cardiomyopathy. J Card Fail [Internet]. 2009;15(5):419–27. Available from:
http://dx.doi.org/10.1016/j.cardfail.2008.11.014
19. Maron MS, Finley JJ, Bos JM, Hauser TH, Manning WJ, Haas TS, et al. Prevalence, clinical significance, and
natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Circulation.
2008;118(15):1541–9.
20. Fattori R, Biagini E, Lorenzini M, Buttazzi K, Lovato L, Rapezzi C. Significance of Magnetic Resonance Imaging
in Apical Hypertrophic Cardiomyopathy. Am J Cardiol [Internet]. 2010;105(11):1592–6. Available from:
http://dx.doi.org/10.1016/j.amjcard.2010.01.020
21. Teraoka K, Hirano M, Ookubo H, Sasaki K, Katsuyama H, Amino M, et al. Delayed contrast enhancement of
MRI in hypertrophic cardiomyopathy. Magn Reson Imaging. 2004;22(2):155–61.
22. Coats CJ, Elliott PM. Current management of hypertrophic cardiomyopathy. Curr Treat Options Cardiovasc
Med. 2008;10(6):496–504.
23. Maron BJ. Hypertrophic cardiomyopathy. Circulation. 2002;106(19):2419–21.
24. Eitel I, Von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, et al. Clinical
characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA
- J Am Med Assoc. 2011;306(3):277–86.
25. Naruse Y, Sato A, Kasahara K, Makino K, Sano M, Takeuchi Y, et al. The clinical impact of late gadolinium
enhancement in Takotsubo cardiomyopathy: Serial analysis of cardiovascular magnetic resonance images. J
Cardiovasc Magn Reson. 2011;13(1):1–9.
26. Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, et al. Transient left ventricular apical
ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction.
J Am Coll Cardiol. 2001;38(1):11–8.
27. Wittstein IS, Thiemann DR, Lima JAC, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral
Features of Myocardial Stunning Due to Sudden Emotional Stress. N Engl J Med. 2005;352(6):539–48.
28. Maréchaux S, Fornes P, Petit S, Poisson C, Thevenin D, Le Tourneau T, et al. Pathology of inverted Takotsubo
cardiomyopathy. Cardiovasc Pathol. 2008;17(4):241–3.
29. Sharkey SW, Windenburg DC, Lesser JR, Maron MS, Hauser RG, Lesser JN, et al. Natural History and
Expansive Clinical Profile of Stress (Tako-Tsubo) Cardiomyopathy. J Am Coll Cardiol [Internet].
2010;55(4):333–41. Available from: http://dx.doi.org/10.1016/j.jacc.2009.08.057
30. Leurent G, Larralde A, Boulmier D, Fougerou C, Langella B, Ollivier R, et al. Cardiac MRI studies of transient
left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): A systematic review. Int J Cardiol
[Internet]. 2009;135(2):146–9. Available from: http://dx.doi.org/10.1016/j.ijcard.2009.03.067
31. Al-Mallah MH, Shareef MN. The role of cardiac magnetic resonance imaging in the assessment of non-
ischemic cardiomyopathy. Heart Fail Rev. 2011;16(4):369–80.
32. Yelgec SN, Dymarkowski S, Ganame J, Bogaert J. Value of MRI in patients with a clinical suspicion of acute
myocarditis. Eur Radiol. 2007;17(9):2211–7.
33. Zagrosek A, Wassmuth R, Abdel-Aty H, Rudolph A, Dietz R, Schulz-Menger J. Relation between myocardial
edema and myocardial mass during the acute and convalescent phase of myocarditis - A CMR study. J
Cardiovasc Magn Reson. 2008;10(1):1–8.
34. Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Ntusi N, et al. T1 Mapping for the
diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced
imaging. JACC Cardiovasc Imaging. 2013;6(10):1048–58.
35. Assomull RG, Lyne JC, Keenan N, Gulati A, Bunce NH, Davies SW, et al. The role of cardiovascular magnetic
resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Eur
Heart J. 2007;28(10):1242–9.
36. Sanghvi SK, Schwarzman LS, Nazir NT. Cardiac MRI and Myocardial Injury in COVID-19: Diagnosis, Risk
Stratification and Prognosis. Diagnostics. 2021;11(1):130.
Published
2021-07-26
How to Cite
HADJI NIKOLOVA, Natasha et al.
ASSESSMENT OF LATE GADOLINIUM ENHANCEMENT IN CARDIAC MRI.
Journal of Morphological Sciences, [S.l.], v. 4, n. 2, p. 163-173, july 2021.
ISSN 2545-4706.
Available at: <http://jms.mk/jms/article/view/vol4no2-22>. Date accessed: 20 apr. 2024.
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