Lyme carditis: persistent local delayed enhancement by cardiac magnetic resonance imaging

Lyme borreliosis (LB) is the most common tick-born disease in the Northern Hemisphere. During early disseminated Lyme disease cardiac manifestation can occur. We report a case of isolated Lyme myocarditis with transitory total atrioventricular (AV)-block and myocardial necrosis indicated by a rise in Troponin-T (TNT). Antibiotic treatment resulted in complete resolution of the AV-block, but a local epimyocardial contrast enhancement persisted as shown by cardiac magnetic resonance imaging (MRI).     

Restitutio ad integrum of femur head necrosis due to early detection using nuclear magnetic resonance tomography

Avascular necrosis of the hip was diagnosed early with magnetic resonance (MR) imaging in a 50-year-old man with pain and slightly diminished function of his right hip. Conservative treatment (non-weight bearing) of the hip led to complete recovery at one year follow-up. This case emphasizes the importance of MR imaging as first evaluation for avascular necrosis of the hip.     

Three-dimensional cardiac magnetic resonance imaging

Evaluation of time-varying cardiac structure and function is challenging because of the three-dimensional (3-D) anatomy and time-varying (4-D) behavior of the heart. Historically, contrast angiography has served as the cornerstone of cardiac diagnosis because of its excellent spatial and temporal resolution. However, magnetic resonance (MR) imaging is now increasingly applied because of the wide variety of available MR imaging and data acquisition techniques, including spin-echo, gradient-echo, wall motion techniques, 1H 31P spectroscopy, and, most recently, echo-planar imaging. Planar 2-D MR imaging is used to characterize many aspects of cardiac structure and function, including anatomic relationships, valvular heart disease, ischemic heart disease, and congenital abnormalities, among others. The development of imaging display and data postprocessing analysis techniques have paralleled the growth of these image and data acquisition schemes and, increasingly, an emphasis has been placed on defining structure and function in 3-D, or even 4-D. Three-dimensional reconstructions of the heart have commonly relied on conventional planar MR image acquisition techniques; a 3-D volume of data is then created from stacked 2-D images. Surface reconstruction and graphical rendering techniques are used to generate representations of the heart that depict 3-D and 4-D cardiac structure and function. These techniques have been used both clinically and experimentally in a variety of settings, including ischemic heart disease, MR coronary angiography, and congenital heart disease.     

Myocardial perfusion imaging by cardiac magnetic resonance.

Cardiovascular magnetic resonance (CMR) has been shown to provide high quality data on cardiac and valvular function, perfusion, viability, blood flow, and potentially, on cardiac metabolism as well. Several of these CMR applications (eg, function and viability assessment) matured during the past years and are now established components of a cardiac workup. Perfusion-CMR is close to this status and is already a major contributor to cardiac examinations in a growing number of expert centers. Large multicenter perfusion-CMR trials comparing the diagnostic performance of CMR with other techniques were recently reported yielding areas under the receiver-operator-characteristics curve as a high as 0.85 for coronary artery disease detection (MR-IMPACT). Anticipating a growing role for perfusion-CMR in cardiology in the near future, this article discusses the principles of perfusion-CMR and its integration into the workup of patient with coronary artery disease (CAD). In addition to a functional study, this integration is mainly composed of a perfusion-CMR part, followed by a viability assessment by late enhancement CMR techniques. The principal characteristics of these CMR techniques are compared with those of single photon emission computed tomography (SPECT) and positron emission tomography (PET). After introduction into principles and techniques of perfusion-CMR, some open questions in perfusion-CMR and challenges for the future are addressed. Finally, newer CMR applications are shortly mentioned utilizing hyperpolarized carbon-13 compounds in experimental models for quantification of myocardial perfusion and for real-time assessment of metabolic pathways in postischemic myocardium.     

Cardiac lipoma diagnosed by cardiac magnetic resonance imaging

A 62-year-old man experienced a transient ischaemic attack.He underwent a transthoracic echocardiogram to rule out thepresence of embolic source. It showed a 10 mm mass with broadattachment to the left side of     

Molecular imaging of vulnerable plaque by cardiac magnetic resonance imaging

Coronary atherosclerosis is known to be the major cause for morbidity and mortality in the industrial world. In Europe, every year approximately 600,000 persons die from coronary artery disease, a majority of them without any prior symptoms. Plaque rupture, mostly of noncalcified vulnerable plaques, is supposed to play a major role in this setting, and noninvasive techniques are mandatory to stratify the individual risk for experiencing an acute coronary event. During the last decade, magnetic resonance imaging has gained importance as a noninvasive imaging technique in cardiology. Continuous technical improvements enabled a rapidly expanding field of application, and recently noninvasive imaging of plaques has been introduced. In addition to morphological characterization, functional imaging of plaques has gained interest for a more specific risk assessment. This article summarizes pathophysiological aspects of the concept of vulnerable plaque, technical requirements for noninvasive plaque imaging, and characterization with magnetic resonance imaging.     

Nuclear magnetic resonance imaging: Potential cardiac applications

During the past several years, the production of high resolution images of organs in intact animals and human beings using nuclear magnetic resonance (nmr) has generated much interest and raised the possibility that the technique could be usefully applied to clinical problems. Because the images are derived from biochemical as well as structural information, valuable data relating to the metabolic status of the tissues and organs may be obtained. Furthermore, nuclear magnetic resonance imaging involves no potentially hazardous ionizing radiation. The technology of the technique is complex and much work remains to be done defining the biochemical and physiologic basis of such images, but the potential rewards of defining the metabolic state of organs such as heart and brain in the intact animal and human justify continued research.     

Hypereosinophilic syndrome with cardiac involvement: early diagnosis by cardiac magnetic resonance imaging

Cardiac manifestation is the major cause of morbidity in patients with hypereosinophilic syndrome (HES) if left untreated. Endomyocardial biopsy is currently the gold standard for diagnosis, although typical findings using noninvasive methods such as cardiac magnetic resonance (CMR), may suggest the diagnosis. The present case provides an example of the beneficial use of cardiac magnetic resonance for early diagnosis and follow-up of patients with cardiac involvement in hypereosinophilic syndrome.     

Comparison of different types of cardiac amyloidosis by cardiac magnetic resonance imaging

Objectives: We sought to determine cardiac morphological and functional differences between light-chain (AL), mutant-type transthyretin (ATTRmt) and wild-type TTR (ATTRwt) amyloidosis using contrast-enhancement cardiac magnetic resonance imaging (CE-CMR). Finally, we attempted to establish the diagnostic and prognostic impact of these findings. Introduction: The most common forms of cardiac amyloid are AL and ATTR amyloidosis, but the clinical courses of these variants are quite heterogeneous. While CE-CMR is used to evaluate patients with cardiac amyloidosis, its ability to predict prognosis in these patients is debatable.

Methods: About 130 patients with cardiac amyloidosis (AL, n?=?62; ATTRmt, n?=?30, ATTRwt, n?=?33) were assessed by CE-CMR (cardiac morphology, cardiac function, late gadolinium enhancement).

Results: Left ventricular (LV) mass, basal and mid-ventricular maximal wall thickness, and thickness of the inter-atrial septum were higher in ATTRwt when compared to AL and ATTRmt amyloidosis. Tricuspid annular excursion was lower in ATTRwt amyloidosis than in AL amyloidosis. CE was observed in 94.6% of the patients (AL 80.6%; ATTRmt 90%; ATTRwt 87.9%) with significant differences in quality and intensity between the groups. Differentiation of amyloid types was achieved by combination of age, number of organs, the presence of inferolateral CE-CMR, thickness of inter-atrial septum and troponin T. Overall 1-year-survival rates were 93.3, 93.9 and 70.5% in ATTRwt, ATTRmt and AL amyloidosis, respectively. LV mass, mitral annular excursion and NT-proBNP in AL amyloidosis, LV mass maximal apical wall thickness and troponin T in ATTRwt amyloidosis, and finally NT-proBNP and renal function in ATTRmt amyloidosis were independent predictors of outcome.

Conclusions: This study demonstrates that CE-CMR can highlight morphological and functional differences between different types of cardiac amyloidosis. In addition, CE-CMR and cardiac biomarkers provide useful prognostic information in patients with cardiac amyloidosis.     

Future prospects in cardiac magnetic resonance imaging

To appreciate the impact that key developments will have on the future of cardiovascular magnetic resonance (CMR) imaging, it is instructive to consider its present status. CMR has passed the threshold of being used primarily by innovators, and is now in the early adopter stage. To reach this threshold has taken many years, but its adoption by early majority users is expected to accelerate the growth of CMR. A number of factors govern its natural growth potential, including physician education and credentialing, scanner availability, technology, and reimbursement policies. The intrinsic dimensional accuracy of CMR, coupled with its high level of reproducibility, make it ideal for inclusion in trials, potentially with dramatic reductions in trial duration and the number of subjects required. Clinically, there are a number of applications for which CMR is widely regarded as being the diagnostic test of choice. Software and hardware developments that speed up the basic CMR procedure are being incorporated into scanners, extending the functionality of routine applications such as flow imaging and tag visualization. Exciting areas that are close to routine application include coronary artery imaging, and evaluation of myocardial perfusion and viability status.     

Diagnosis of acute myocarditis by contrast-enhanced cardiac magnetic resonance imaging

Myocarditis is defined as an inflammatory process of the heart muscle. The symptoms are often nonspecific, and it can mimic acute coronary syndrome. Although the majority of patients recover fully, in some cases myocarditis can lead to dilated cardiomyopathy and even death. Available diagnostic tools are unsatisfactory and there is a need to develop noninvasive techniques that can aid diagnosis, prognosis, and follow-up. Contrast-enhanced magnetic resonance imaging is a valuable tool for the evaluation of inflammatory heart diseases such as myocarditis. We describe a 39-year-old man presenting in the emergency department with chest pain, ST segment elevation and elevated cardiac enzymes, who was treated initially with thrombolysis. Coronary angiography showed normal coronary arteries. Magnetic resonance imaging showed focally delayed uptake of gadolinium with a patchy pattern typical of myocarditis.