Cardiac MRI: Cardiomyopathy
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1 Cardiac MRI: Cardiomyopathy Laura E. Heyneman, MD I do not have any relevant financial relationships with any commercial interests
2 Cardiac MRI: Cardiomyopathy Laura E. Heyneman, MD Duke University Medical Center
3 Outline Delayed enhancement patterns Specific myopathies: RV dilated CM sarcoid LV RA LA LV hypertrophic
4 Cine Imaging Breath held SSFP; real-time Wall motion, valves RV LA RV LV LV LA LV RA LA LV short axis 2 chamber 4 chamber
5 Delayed Enhancement IR gradient echo spoiled gradient echo, SSFP short axis 3 chamber 4 chamber
6 Delayed Enhancement IR gradient echo 5-15 minutes after IV contrast short axis 2 chamber 4 chamber
7 Delayed Enhancement Normal myocardium nulled short axis 3 chamber 4 chamber
8 Delayed Enhancement Delayed enhancement = abnormal Infarct Cardiol Clin 2007; 25: RadioGraphics 2006; 26:
9 Delayed Enhancement Delayed enhancement = abnormal Infarct Cardiol Clin 2007; 25: Myocarditis RadioGraphics 2006; 26:
10 Delayed Enhancement Is enhancement in an ischemic pattern? Infarct Cardiol Clin 2007; 25: Myocarditis RadioGraphics 2006; 26:
11 CAD Enhancement Subendocardial Transmural
12 CAD Enhancement subendocardial transmural
13 CAD Enhancement subendocardial transmural
14 Enhancement: Non-CAD Patterns Mid-myocardial Epicardial RV insertion Diffuse subendocardial
15 Non-CAD Pattern: Midmyocardial AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
16 Non-CAD Pattern: Midmyocardial Myocarditis Hypertrophic Dilated CM Sarcoidosis Chagas disease
17 Non-CAD Pattern: Midmyocardial myocarditis
18 Non-CAD Pattern: Midmyocardial hypertrophic CM
19 Non-CAD Pattern: Epicardial Int J Cardiovasc Imaging 2008;24:
20 Non-CAD Pattern: Epicardial Myocarditis Sarcoidosis Chagas disease AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
21 Non-CAD Pattern: Epicardial Sarcoid Int J Cardiovasc Imaging 2008;24:
22 Non-CAD Pattern: RV insertion site AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
23 Non-CAD Pattern: RV insertion site RV overload AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
24 Non-CAD Pattern: RV insertion site Pulmonary valve stenosis
25 Non-CAD Pattern: RV insertion site Pulmonary valve stenosis
26 Non-CAD Pattern: RV insertion site Pulmonary valve stenosis
27 Non-CAD Pattern: diffuse subendocardial AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
28 Non-CAD Pattern: diffuse subendocardial Amyloidosis System sclerosis Cardiac trxplt (Uremic CM) AJR 2005; 184: Int J Cardiovasc Imaging 2008;24:
29 Non-CAD Pattern: diffuse subendocardial Amyloid Int J Cardiovasc Imaging 2008;24:
30 Non-CAD Pattern: diffuse subendocardial Amyloid Int J Cardiovasc Imaging 2008;24:
31 Myocardial Diseases
32 Dilated cardiomyopathy: ischemic or not?
33 56 yo CHF; EtOH; known CAD (LCx > 50%)
34 Ischemic Nonischemic RV spared Focal thinning Biventricular Uniform wall
35 Ischemic Nonischemic Enhancement: subendocardial, Enhancement: none transmural
36 Ischemic Nonischemic Enhancement: subendocardial, Enhancement: none transmural
37 Ischemic Nonischemic Enhancement: subendocardial, transmural Enhancement: none, nonischemic
38 Nonischemic Cardiomyopathy No Enhancement Alcoholic, Post-partum, Idiopathic Circulation 2003;108:54-59
39 Nonischemic Cardiomyopathy 40% idiopathic CM nonischemic pattern: midwall Circulation 2003; 108(1): 54-59
40 56 yo CHF; EtOH; known CAD (LCx > 50%)
41 56 yo CHF; EtOH; known CAD (LCx > 50%)
42 Nonischemic Cardiomyopathy
43 Alcoholic Cardiomyopathy
44 Revascularization? probably not improve
45 Sudden cardiac death in young patient:? cause
46 Sudden Cardiac Death in Young Patient Cardiac sarcoid Hypertrophic CM Arrhythmogenic RV dysplasia Anomalous coronary
47 Sudden Cardiac Death in Young Patient Cardiac sarcoid Hypertrophic CM Arrhythmogenic RV dysplasia Anomalous coronary
48 Sudden Cardiac Death in Young Patient Cardiac sarcoid Hypertrophic CM Arrhythmogenic RV dysplasia Anomalous coronary
49 Sudden Cardiac Death in Young Patient Cardiac sarcoid Hypertrophic CM Arrhythmogenic RV dysplasia Anomalous coronary
50 Cardiac Sarcoidosis Multi-organ system 5% clinical cardiac dz Risk of arrhythmia, SCD Treatment: defibrillator
51 Sarcoidosis RA LA Aneurysm Heart Block, Arrhythmia RV LV Mitral Regurg Adapted from Am J Med 1977;63(1): Granuloma deposition
52 Japanese Ministry of Health Criteria A + at least 1 from B-D Criteria A: Abnormal EKG or holter Criteria B: Abnormal ECHO Criteria C: Abnormal nuclear study (perfusion defect or abnormal 67-Ga citrate scan) Criteria D: Abnormal cath (abnormal wall motion or EF)
53 MRI spatial resolution surpasses ECHO, nucs Cardiol Clin 2007; 25: AJR 2005; 184:
54 45 yo, lung sarcoid, normal cath, +/- ECHO Aneurysm Cardiol Clin 2007; 25: AJR 2005; 184:
55 Delayed Enhancement often nonischemic pattern Circulation 2004;108:645 (suppl)
56 Patel: 70 pts sarcoid 24% + enhancement (2x Japanese criteria) Circulation 2006; 114 (suppl II): 408
57 Patel: 70 pts sarcoid enhancement patterns transmural: nl coronaries Circulation 2006; 114 (suppl II): 408 Transmural
58 Patel: 70 pts sarcoid enhancement patterns 82% focus nonischemic Circulation 2006; 114 (suppl II): 408 Mid-myocardial
59 Patel: 70 pts sarcoid enhancement patterns 82% focus nonischemic Circulation 2006; 114 (suppl II): 408 Epicardial
60 Patel: 70 pts sarcoid DE: independent predictor of cardiac events Circulation 2006; 114 (suppl II): 408 Cardiol Clin 2007; 25:
61 Delayed Enhancement? before function abnormal J Comput Assist Tomogr.2005;29:745-8
62 Delayed Enhancement target endomyocardial bx J Comput Assist Tomogr.2005;29:745-8
63 Sudden Death in Young Patient Cardiac sarcoid Hypertrophic CM Arrhythmogenic RV dysplasia Anomalous coronary
64 Hypertrophic Cardiomyopathy LV hypertrophy, no cause Genetic Sudden death: arrhythmia, LVOT obstruction
65 Hypertrophic Cardiomyopathy: Wall thickness > 1cm N Engl J Med 2004; 350:
66 Hypertrophic Cardiomyopathy: Concentric hypertrophy N Engl J Med 2004; 350:
67 Hypertrophic Cardiomyopathy: Asymmetric: apical
68 Hypertrophic Cardiomyopathy: Asymmetric: septal N Engl J Med 2004; 350:
69 Hypertrophic Cardiomyopathy: Septal:?LVOT obstruction
70 Hypertrophic Cardiomyopathy: Septal:?LVOT obstruction
71 Hypertrophic Cardiomyopathy: Jet / turbulent flow in LVOT
72 Characteristic SAM: Systolic Anterior Motion of anterior leaflet MV
73 Hypertrophic Obstructive Cardiomyopathy (HOCM)
74 Delayed enhancement: patchy, midmyocardial Mag Res Imaging 2004; 22(2):
75 Delayed enhancement: jxn of septum, RV free wall Mag Res Imaging 2004; 22(2):
76 Delayed enhancement: 81% HCM patients: + scar J Am Coll Cardiol 2002; 40:
77 Delayed enhancement: + collagen;? ischemia J Am Coll Cardiol 1986; 8 (3): J Am Coll Cardiol 2004; 43 (12):
78 Delayed enhancement:? arrhythmogenic foci Mag Res Imaging 2004; 22(2):
79 Delayed enhancement:? scar: risk SCD? Circulation 2002; 106; 652
80 Delayed enhancement: LVDT > 3 cm; risk SCD J Am Society Echocardiogr 2006; 19(6):
81 Treatment for HOCM: EtOH ablation Pre ablation J Am Coll Cardiol 2004; 43(1):27-34.
82 Treatment for HOCM: EtOH ablation Pre ablation Post ablation
83 Treatment for HOCM: EtOH ablation LAD infarction post ablation
84 Laura E. Heyneman, MD
85 Unknown case 1
86 45 yo, arrhythmia Delayed enhancement
87 Lateral wall dyskinesis
88 Transmural enhancement
89 Epicardial enhancement
90 Epicardial enhancement: nonischemic cardiomyopathy
91 Nonischemic cardiomyopathy:? sarcoid,? myocarditis
92 Chagas disease
93 Unknown case 2
94 40 yo,dyspnea,anasarca
95 Bilateral reticulonodular; confluent opacity in RML
96
97
98
99
100 DE DE
101 Abnormal lung signal DE DE
102 LV + RV hypertrophy DE DE
103 diffuse subendocardial DE DE DE
104 RV enhancement DE DE
105 Amyloid (pulmonary + cardiac)
106 Laura E. Heyneman, MD
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