[MRI in cardiac sarcoidosis and amyloidosis]. / MRT bei kardialer Sarkoidose und Amyloidose.

CLINICAL/METHODICAL ISSUE: Sarcoidosis and amyloidosis are both multisystem disorders, which may involve the heart; however, isolated cardiac disease is rare. Diagnosis of cardiac sarcoidosis and amyloidosis is crucial because the patient prognosis is dependent on cardiac involvement and early treatment. STANDARD RADIOLOGICAL METHODS: Echocardiography is the first line imaging modality in the diagnostic work-up of both diseases, possibly giving hints towards the correct diagnosis. Besides myocardial biopsy and radionuclide studies cardiac magnetic resonance imaging (MRI) is routinely performed in patients suspect of having infiltrative cardiomyopathy. METHODICAL INNOVATIONS: The T1 mapping procedure is currently being evaluated as a new technique for detection and quantification of global myocardial enhancement, as seen in cardiac amyloidosis. PERFORMANCE: Sensitivities and specificities for detection of cardiac sarcoidosis and amyloidosis can be significantly improved by MRI, especially with late gadolinium enhancement (LGE) imaging. In cardiac sarcoidosis the use of LGE is outcome-related while in amyloidosis analysis of T1-mapping may be of prognostic value. PRACTICAL RECOMMENDATIONS: If cardiac involvement in sarcoidosis or amyloidosis is suspected cardiac MRI including LGE should be performed for establishing the diagnosis.

MR first pass perfusion of benign and malignant cardiac tumours-significant differences and diagnostic accuracy.

OBJECTIVES: To determine the diagnostic value of magnetic resonance (MR) first pass perfusion in the differentiation of benign and malignant cardiac tumours. METHODS: 24 patients with cardiac tumours (11 malignant, histopathological correlation present in all cases) were examined using MRI. In addition to morphological sequences a saturation-recovery T1w-GRE technique was implemented for tumour perfusion. The maximum relative signal enhancement (RSE[%]) and the slope of the RSE(t)-curve (slopeRSE[%/s]) of tumour tissue were assessed. A t-test was used to identify significant differences between benign and malignant tumours. Sensitivities and specificities were calculated for detection of malignant lesions and were compared with the sensitivity and specificity based on solely morphological image assessment. RESULTS: The RSE and slopeRSE of malignant cardiac tumours were significantly higher compared with benign lesions (p < 0.001 and p < 0.001). The calculated sensitivities and specificities of RSE and slopeRSE for identification of malignant lesions were 100% and 84.6% and 100% and 92.3%, respectively with cut-off values of 80% and 6%/s. The sensitivity and specificity for identification of malignant lesions on the basis of morphological imaging alone were 90.9% and 69.2%. CONCLUSIONS: With first pass perfusion, malignant cardiac masses can be identified with higher sensitivity and specificity compared with morphological image assessment alone.

Contrast enhanced IR-SSFP examination compared with T1-weighted turbo spin-echo imaging of cardiac tumors and tumorlike lesions.

PURPOSE: To show that the use of an early and delayed contrast enhanced multislice inversion recovery steady state free precession (SS-IR-SSFP) is a valuable substitute for conventional post-contrast fat saturated turbo spin-echo (TSE) T1-weighted images in the assessment of cardiac tumors. MATERIALS AND METHODS: 34 consecutive patients referred for MRI in order to assess cardiac tumors were examined. Shortly after administration of gadopenetate dimeglumine (Gd-DTPA) images were obtained using a SS-IR-SSFP sequence. The inversion time (TI) was set at 350ms to achieve a good demarcation of intracavitary tumor spread. Hereafter 9 slices of a T1w TSE sequence were obtained. Finally a SS-IR-SSFP sequence with an optimized TI to null normal myocardium was employed. Quantitative comparisons were performed by calculating contrast to noise ratios of tumor/myocardium (CNR(tumor/myo)) and CNR of tumor/left ventricular cavity (CNR(tumor/LVC)). Image quality was assessed regarding overall image quality, artifacts and tumor conspicuity. RESULTS: Neither calculation of CNR(tumor/LVC) when comparing the early IR-SSFP and T1w TSE, nor calculation of CNR(tumor/myo) when comparing the late IR-SSFP and T1w TSE sequence resulted in statistically significant differences. However, qualitative assessments revealed significant superior results for the early and the late IR-SSFP images compared to the T1-weighted TSE images (p<0.001). CONCLUSIONS: Image quality and tumor conspicuity were superior and image degradation by artifacts was less on IR-SSFP images compared to TSE images without loss of CNR. Thus the use of IR-SSFP sequences is an attractive alternative imaging method compared to post-contrast T1w TSE imaging in the assessment of cardiac tumors.

[Cardiac functional analysis with MRI]. / Kardiale Funktionsanalyse mittels MRT.

Cardiovascular diseases (CVD) are among the leading causes of death worldwide. Even in the 21(st) century CVD will still be the most frequent cause of morbidity and mortality. Precise evaluation of cardiac function is therefore mandatory for therapy planning and monitoring. In this article the contribution of MRI-based analysis of cardiac function will be addressed. Nowadays cine-MRI is considered as the standard of reference (SOR) in cardiac functional analysis. ECG-triggered steady-state free precession (SSFP) sequences are mainly used as they stand out due to short acquisition times and excellent contrast between the myocardium and the ventricular cavity. An indispensible requirement for cardiac functional analysis is an exact planning of the examination and based on that the coverage of the whole ventricle in short axial slices. By means of dedicated post-processing software, manual or semi-automatic segmentation of the endocardial and epicardial contours is necessary for functional analysis. In this way end-diastolic volume (EDV), end-systolic volume (ESV) and the ejection fraction (EF) are defined and regional wall motion abnormalities (RWMA) can be detected.

[Late gadolinium enhancement in the diagnostics of ischemic heart disease: technical principles, contrast optimization and clinical application]. / Late-Gadolinium-Enhancement in der Diagnostik der koronaren Herzerkrankung : Technische Grundlagen, Kontrastoptimierung und klinische Anwendung.

BACKGROUND: The purpose of the study was to explore a "dark blood" technique and to compare it with a standard inversion recovery gradient echo (IR GRE) sequence in the visualization of myocardial infarction. PATIENTS AND METHODS: A total of 9 patients were examined with standard IR GRE and a "dark blood" sequence 15 mins after contrast medium application (0.2 mmol/kg body weight gadobenate dimeglumine). Contrast-to-noise ratios (CNR) were calculated for each sequence. RESULTS: The CNR(inf-lvc) was significantly higher in the "dark blood" technique compared to the IR GRE sequence, while the CNR(inf-myo) was significantly lower. CONCLUSIONS: Small subendocardial infarctions may be easier to detect with the "dark blood" technique. However, the standard IR GRE sequence is superior in the demarcation of infarctions in relation to the myocardium and cannot be replaced by the "dark blood" technique.