Cardiac and Paracardiac Masses: Complementary Role of Echocardiography and Magnetic Resonance Imaging

The objective of this study was to compare the roles of echocardiography and magnetic resonance imaging (MRI) in the evaluation of patients suspected of having cardiac and paracardiac masses. Echocardiography is a widely available and useful technique for characterizing cardiac and paracardiac abnormalities but suffers from a limited field of view and restricted acoustic access to mediastinal structures. MRI is an alternative noninvasive imaging technique for investigation of these abnormalities. Fourteen consecutive patients suspected of having cardiac or paracardiac masses on echocardiography were referred for cardiac MRI. MRI gave more complete visualization in four patients with infiltrating lung tumors and in one patient with intracardiac metastases who had a technically inadequate echo. Echo showed a rapidly moving Chiari network not seen on MRI. Both echo and MRI were helpful in patients with hiatal hernias (2); lipomatous hypertrophy of the interatrial septum (2); left atrial myxoma (1); and calcified mitral annulus (3). We conclude that echocardiography and MRI should be used together to investigate patients with cardiac and paracardiac masses.     

Imaging in Cardiac Echinococcosis

Cardiac echinococcosis is a rare disease. Its diagnosis is sometimes difficult and requires medical imaging such as echocardiography. An 18-year-old man with multiple cardiac hydatid cysts diagnosed by echocardiography and nuclear magnetic resonance is presented. The results from these imaging techniques are presented.     

Cardiovascular Magnetic Resonance Imaging For Assessment Of Cardiac Thrombus

Cardiac thrombus provides a substrate for embolic events and an indication for anticoagulant therapy. Cardiac magnetic resonance (CMR) imaging enables thrombus to be detected based on intrinsic tissue characteristics related to avascular tissue composition. Delayed enhancement CMR tissue characterization has been well validated for thrombus assessment using references of both pathology and clinical thromboembolic outcomes. Comparative studies have demonstrated CMR to yield improved thrombus detection compared to echocardiography, which typically detects thrombus based on anatomic appearance. Experimental studies have demonstrated the feasibility of targeted CMR contrast agents for assessing thrombus composition and chronicity. This review examines established and emerging literature on use of CMR for assessing cardiac thrombus.     

磁共振成像对高血压性心脏病左心室肥厚的诊断价值

对 2 5例原发性高血压、血压≥ 16 0 /90mmHg ,且经过心电图、心脏远达距离摄片、超声心动图检查 ,其中至少一项符合左心室肥厚 (LVH)标准的患者 ,进行磁共振扫描成像 (MRI) ,并与上述检测结果对比 ,以估价MRI对高血压性心脏病LVH的诊断价值。结果表明 ,MRI对LVH的诊断率 (96 % )明显高于超声心动图(5 6 % )、X线 (40 % )和心电图 (2 8% )对LVH的诊断率 (P均 <0 .0 1)。且MRI可测定收缩及舒张期室壁厚度 ,可对LVH准确分型 ,可对比心脏大小、心室容量及心肌重量。MRI对LVH是一种极好的诊断方法     

Cardiovascular Imaging: A Glimpse Into The Future

In a relatively short span, technological developments in cardiovascular imaging have infiltrated every aspect of practice, with noticeable improvements in diagnosis and impact on patient management. All imaging technologies have undergone continual improvements since their inception to a point that imaging has become essential in both clinical practice and research. This article provides a glimpse into the future of cardiovascular imaging and highlights areas of imaging that still need improvement, with a view towards improving the practice of health care, where efficiency and value are becoming ever more dominant criteria throughout the continuum of care.     

散发性Creutzfeldt-Jakob病7例影像学特点分析

目的分析散发性Creutzfeldt-Jakob病(sCJD)的影像学特征,旨在提高临床医生对此病的认识和诊断水平。方法总结河北医科大学附属唐山工人医院2004—2009年临床诊断为sCJD的患者7例,对其病后第1～12个月进行头部影像学检查(CT、MRI)。结果所有患者头部CT检查未见底节区异常改变,3例可见脑萎缩;头部MRI检查可见1例双侧尾状核、壳核于T2加权像(T2WI)高信号,3例FLAIR序列呈对称性高信号,T1加权像无改变;6例分别可见双侧尾状核、壳核、丘脑弥散加权成像(DWI)上可见对称性高信号,2例DWI上可见皮层不对称性高信号,且异常信号随病情时间进展而变化。结论 sCJD临床表现以快速发展的进行性痴呆和肌阵挛最具特点,其影像学异常改变在特定的临床背景下可成为sCJD临床诊断依据之一。     

Evaluation of the Severity of Mitral Regurgitation by the Use of Signal Void in Magnetic Resonance Imaging

Background: The study was designed to evaluate the severity of mitral regurgitation by cardiac magnetic resonance imaging (MRI). We proposed a new measurement of signal void by MRI and tried to define threshold values for the severity of regurgitation with different sequences. Methods: Twenty‐one patients with mitral regurgitation were evaluated by echocardiography and MRI. We measured the length, width, and the area of jet flow void from long‐axis and four‐chamber views. The regurgitant area was measured with TrueFISP, FLASH sequences, and phase images by tracing the signal‐void area in left atrium parallel to mitral annulus. This new parameter for grading of the severity of mitral regurgitation by cine MRI was called regurgitant area from short axis (RAFSA). Results: All methods (EROA, vena contracta) were correlated for determining the regurgitation severity (P < 0.01). There was a correlation between EROA by echocardiography and RAFSA by MRI with the TrueFISP, FLASH sequences, and phase images (P < 0.01). Stepwise regression analysis revealed that EROA was significantly correlated with RAFSA by phase images (P < 0.001). After regression analysis, threshold values of RAFSA by phase imaging were calculated and found to be 0.27 cm² and 0.92 cm² between mild, moderate, and severe mitral regurgitations (100% sensitivity, 67% specificity, and 100% sensitivity, 78% specificity, respectively) (P < 0.01, P < 0.05). Conclusions: MRI is an alternative method for evaluating mitral regurgitation. Our study suggests a new parameter, RAFSA by cine MRI, to grade the severity of mitral regurgitation and provides threshold values in order to define mild, moderate, and severe regurgitations. (ECHOCARDIOGRAPHY, Volume **, ***********)     

The Role of Three‐Dimensional Echocardiography in Interventricular Mass Evaluation

A young patient underwent a screening electrocardiogram (EKG) that suggested apical hypertrophic cardiomyopathy. Serial investigation with echocardiography showed a well‐defined hyperechogenic mass involving the interventricular septal. To better define the lesion extension three‐dimensional (3D) echocardiography was done and it demonstrated a mass invading the septal myocardium, involving the major part of the muscular portion. The findings were highly suggestive of a cardiac fibroma. A cardiac magetic resonance image (MRI) was also compatible with this diagnosis. In our case, 3D echo showed a high accuracy, proving to be a useful tool to determine the anatomy of the lesion, complementary to MRI, guiding best management strategy.     

Magnetic Resonance Imaging in Chronic Chagas' Disease

Background: We studied the correlation among cardiac magnetic resonance imaging (MRI), gallium-67 myocardial uptake, and right ventricular endomyocardial biopsy results in chronic Chagas' disease. To our knowledge, this represents the first attempt to correlate the histological findings with cardiac MRI and gallium-67 myocardial uptake for noninvasive diagnosis of inflammatory activity associated with Chagas' disease. Methods: Ten male patients with cardiomyopathy secondary to Chagas' disease were studied (mean age, 47.7 ± 7 years; congestive heart failure New York Heart Association [NYHA] functional class II [two patients], III [six patients], and IV [two patients]; and mean echocardiographic left ventricular [LV] ejection fraction [EF], 36 ± 6%). The patients underwent right ventricular endomyocardial biopsy, cardiac MRI, and gallium-67 myocardial uptake testing. The results of this group were compared with those of a control group of patients with idiopathic dilated cardiomyopathy who were matched in age (mean age, 46 ± 10 years), LV function (mean echocardiographic EF, 30 ± 4%), and NYHA classification (one patient in class II, five patients in class III, and one patient in class IV). Results: All patients with Chagas' disease showed higher signal intensity on MRI after the administration of gadolinium. The intensity of the septal signal changed from 0.90 ± 0.11 to 1.56 ± 0.19 (P < 0.001). In the control group, there was no difference in signal intensity with gadolinium (mean septal intensity, 0.94 ± 0.12 before and 0.99 ± 0.15 after; NS). On biopsy, eight chagasic patients had evident signs of myocarditis, and two patients had borderline evidence myocarditis. However, only one patient in the control group had a histological diagnosis of borderline myocarditis. Gallium-67 cardiac uptake was positive for myocardial inflammatory process in seven chagasic patients and borderline in one. On the other hand, only one patient in the control group had an uptake that was positive for inflammation, and one had a borderline result. Conclusions: In conclusion, the data from this study strongly suggest that myocarditis is frequently found in Chagas' disease. Cardiac MRI appears to be an accurate and alternative method for the diagnosis of inflammatory process associated with Chagas' disease.     

Imaging Modalities in the Diagnosis of Acute Aortic Dissection

The management of patients with acute aortic dissection requires a rapid diagnosis and precise information about the localization and extent of the dissection. Four imaging techniques are currently available to diagnose aortic dissection: aortography; contrast-enhanced computerized tomography (CECT); magnetic resonance imaging (MRI); and transesophageal echocardiography (TEE). All of these techniques have their specific advantages and inherent limitations. Recent studies have demonstrated that MRI may best provide a comprehensive and detailed evaluation of the thoracic aorta, therefore proposing this technique as a "new gold standard" in the diagnosis of acute aortic dissection. TEE, however, may be the best alternative technique, as it combines high sensitivity and specificity with high practicality. The practicality is particularly important in hemodynamically unstable patients in whom a rapid bedside imaging modality is required. CECT might be necessary in selected cases in whom TEE fails to provide a definite diagnosis. Aortography may be necessary in patients in whom clinical signs are suggestive of organ ischemia and in whom coronary anatomy needs to be delineated before operation.