CMR approach in cardiac tumours

2018 ◽  
pp. 466-468
Author(s):  
Cristina Basso ◽  
Peter T Buser ◽  
Stefania Rizzo ◽  
Massimo Lombardi ◽  
Gaetano Thiene
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Function ◽  
Tissue Characterization ◽  
Cardiac Tissue ◽  
Malignant Tumours ◽  
Magnetic Resonance Scanner ◽  
Cardiac Tumours ◽  
Cardiac Masses ◽  
Cmr Imaging

Cardiovascular magnetic resonance (CMR) imaging of cardiac masses provides a multplicity of information, e.g. on localization, extension, dimensions, infiltration of cardiac and/or peri-/para-cardiac tissue, influence on cardiac function and flow, vascularization of the mass, and most importantly tissue characterization. However, since time to investigate a patient within the magnetic resonance scanner is limited, it is recommended to follow published CMR protocols in order to perform highly efficient CMR examinations and nevertheless receive optimized information per unit of investigational time. Furthermore, some criteria may allow differentiation of benign from malignant tumours.

scholarly journals Society for Cardiovascular Magnetic Resonance (SCMR) recommended CMR protocols for scanning patients with active or convalescent phase COVID-19 infection

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Sebastian Kelle ◽  
Chiara Bucciarelli-Ducci ◽  
Robert M. Judd ◽  
Raymond Y. Kwong ◽  
Orlando Simonetti ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Function ◽  
Tissue Characterization ◽  
Clinical Indication ◽  
Myocardial Tissue ◽  
Clinical Question ◽  
Convalescent Phase ◽  
Myocardial Tissue Characterization

Abstract The aim of this document is to provide specific recommendations on the use of cardiovascular magnetic resonance (CMR) protocols in the era of the COVID-19 pandemic. In patients without COVID-19, standard CMR protocols should be used based on clinical indication as usual. Protocols used in patients who have known / suspected active COVID-19 or post COVID-19 should be performed based on the specific clinical question with an emphasis on cardiac function and myocardial tissue characterization. Short and dedicated protocols are recommended.

scholarly journals Cardiac Tissue Characterization and the Diagnostic Value of Cardiovascular Magnetic Resonance in Systemic Connective Tissue Diseases

2013 ◽  
Vol 66 (1) ◽  
pp. 104-112 ◽  
Author(s):  
Sophie Mavrogeni ◽  
Petros P. Sfikakis ◽  
Elias Gialafos ◽  
Konstantinos Bratis ◽  
Georgia Karabela ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Connective Tissue ◽  
Tissue Characterization ◽  
Cardiac Tissue ◽  
Connective Tissue Diseases ◽  
Diagnostic Value

The Improvement of Torsion Assessed by Cardiovascular Magnetic Resonance Feature Tracking after Coronary Artery Bypass Grafting: A Sensitive Index of Cardiac Function

2017 ◽  
Vol 20 (1) ◽  
pp. 026 ◽  
Author(s):  
Nan Cheng ◽  
Liuquan Cheng ◽  
Rong Wang ◽  
Lin Zhang ◽  
Changqing Gao
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Feature Tracking ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Rapid Acquisition ◽  
Left Ventricular Torsion ◽  
Ventricular Torsion

Objective: The aim of this study was to quantify left ventricular torsion by newly applied cardiovascular magnetic resonance feature tracking (CMR-FT), and to evaluate the clinical value of the ventricular torsion as a sensitive indicator of cardiac function by comparison of preoperative and postoperative torsion.Methods: A total of 54 volunteers and 36 patients with previous myocardial infarction (MI) and LV ejection fraction (EF) between 30%-50% were screened preoperatively or postoperatively by MRI. The patients’ short axis views of the whole heart were acquired, and all patients had a scar area >75% in at least one of the anterior or inferior segments. Their apical and basal rotation values were analyzed by feature tracking, and the correlation analysis was performed for the improvement of LV torsion and ejection fraction after CABG. The intra- and inter-observer reliabilities of torsion measured by CMR-FT were assessed.Results: In normal hearts, the apex rotated counterclockwise in the systolic period with the peak rotation as 10.2 ± 4.8°, and the base rotated clockwise as the peak value was 7.0 ± 3.3°. There was a timing hiatus between the apex and base untwisting, during which period the heart recoils and its suction sets the stage for the following rapid filling period. The postoperative torsion and rotation significantly improved compared with preoperative ones. However, the traditional indicator of cardiac function, ejection fraction, didn’t show significant improvement.Conclusion: Left ventricular torsion derived from CMR-FT, which does not require specialized CMR sequences, was sensitive to patients with low ejection fraction whose cardiac function significantly improved after CABG. The rapid acquisition of this measurement has potential for the assessment of cardiac function in clinical practice. 

Cardiovascular magnetic resonance to predict clinical outcome in chronic total coronary artery occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Khedr Abdelaty ◽  
C Budgeon ◽  
G.S Gulsin ◽  
S Hetherington ◽  
K Khunti ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Composite Endpoint ◽  
Coronary Artery Occlusion ◽  
Stress Perfusion ◽  
Funding Source ◽  
Collateral Flow ◽  
Cmr Imaging

Abstract Background Chronic total coronary artery occlusions (CTOs) are present in approximately 20–30% of patients undergoing invasive angiography. Despite their prevalence, the optimum management strategy of CTOs remains uncertain. A potential limitation in published trials of CTO revascularisation is their failure to incorporate systematic assessment of ischaemia/viability in informing revascularisation decisions. Aim We sought to determine the prognostic utility of ischaemia/viability assessment by cardiovascular magnetic resonance (CMR) in a large, contemporaneous, real-world CTO population. Methods We retrospectively studied consecutive adult patients with≥1angiographically identified CTO who were referred for clinical CMR imaging during a consecutive 8-year period in our centre (2010–2018). Multi-parametric CMR comprised functional assessment, adenosine-stress perfusion and scar imaging. For perfusion assessment, images were analysed qualitatively with a concurrent examination of scar images. Myocardial segments were assigned to CTO or non-CTO territories according to standard criteria, taking into account coronary dominance. Significant ischaemia was defined as ≥10% and/or ≥2 contiguous myocardial segments with hibernation. Angiographic collateral flow to the CTO territory was graded using the Rentrop classification and the Collateral Connection (CC) Score. Significant CAD in non-CTO vessels was defined angiographically as ≥50% stenosis in any epicardial coronary artery/branch with diameter ≥2mm. The composite clinical endpoint comprised all-cause mortality, myocardial infarction and heart failure hospitalisation. Results From a total of 27,201 invasive angiograms performed during the study period, 389 patients were diagnosed with CTO and underwent CMR imaging (mean age 65.0±11.0 years, 84% male). CTO was present most frequently in the right coronary artery (59% of subjects, 229/389), with left circumflex (LCx) artery involvement in 29% (112/389) and left anterior descending (LAD) artery in 29% (111/389). Collaterals with CC grade ≥2 were identified in 186 subjects (48%), and Rentrop score ≥2 in 300 (77%). Significant ischaemia was present in 61% of patients, and infarction in 71% (median infarction 8.6% [interquartile range (IQR) 4.5–14.1]. With a median follow-up time of 3.30 years [IQR 0.04–8.64], 65 (17%) met the composite endpoint. On multivariate analysis, neither significant ischaemia nor infarction was associated with the composite endpoint. However, non-CTO territory ischaemia was independently predictive of adverse outcome (hazard ratio 1.93; 95% CI 1.16–3.21; p=0.0113). Conclusion CTO-territory ischaemia and infarction are not predictive of adverse clinical outcome, challenging the assertion that CTO revascularisation may be guided by ischaemia assessment. The finding that non-CTO territory ischaemia is associated with adverse cardiovascular events warrants further investigation. Kaplan-Meier curves_CTO Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

scholarly journals Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
EC D"angelo ◽  
P Paolisso ◽  
L Bergamaschi ◽  
A Foa ◽  
I Magnani ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pericardial Effusion ◽  
Tissue Characterization ◽  
Descriptive Analysis ◽  
Gadolinium Enhancement ◽  
Malignant Lesions ◽  
T1 And T2 ◽  
Cardiac Masses

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background  Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose  To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours.  Results  The descriptive analysis of the morphologic features showed that diameter > 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p <0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002).  Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor.  Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

Interferon-gamma inducible protein IP-10 and left ventricular remodelling post-acute myocardial infarction: a longitudinal cardiovascular magnetic resonance imaging substudy of CAPRI clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Sopova ◽  
C Park ◽  
A Al-Atta ◽  
K Bennaceur ◽  
A Mohammad ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Linear Regression Analysis ◽  
Left Ventricular ◽  
Lv Remodeling ◽  
Inducible Protein ◽  
Cmr Imaging

Abstract Background Adverse left ventricular (LV) remodelling is associated with development of heart failure and poor outcomes in patients with acute myocardial infarction (AMI). Understanding the immunomodulatory mechanisms of LV remodelling is an essential step for the development of novel therapies. Interferon-γ-inducible protein-10 (IP-10)/CXCL10 is a chemokine involved in the recruitment of activated T cells into sites of tissue inflammation. Although IP-10 was reported to reduce adverse LV remodeling in a preclinical myocardial infarction model, its role in LV remodeling in humans with AMI remains unknown. Purpose To determine the clinical predictive value of serum IP-10 in LV remodeling in patients with ST-segment elevation myocardial infarction (STEMI). Methods This is a substudy of the double-blind, randomised controlled trial “Evaluating the effectiveness of intravenous ciclosporin on reducing reperfusion injury in patients undergoing primary percutaneous coronary intervention” (CAPRI; ClinicalTrials.gov registry number NCT02390674), which enrolled 52 acute STEMI patients. LV remodeling was assessed by cardiovascular magnetic resonance (CMR) imaging and was defined as the 12-week vs. the 3-day post-myocardial infarction change of the left ventricular ejection fraction (ΔLVEF), LV end-diastolic volume (ΔEDV) or LV end-systolic volume (ΔESV). Serum IP-10 was measured before and 5min, 15min, 30min, 90min and 24h after reperfusion by ELISA. Linear regression analysis was used to determine the independent association of IP-10 with the endpoints of the study. Results Serum IP-10 concentration peaked at 30min after reperfusion followed by a 2-fold decrease at the 24h post reperfusion compared to pre-reperfusion levels (P<0.001 for all). Comparison of the 12-week CMR to the baseline CMR imaging revealed that baseline pre-reperfusion as well as 5min, 15min, 30min and 90min, but not 24h, post-reperfusion IP-10 serum levels associated with increased LVEF and decreased ESV at 12-weeks (range correlation coefficient r=[0.35–0.41], P<0.05 with ΔLVEF and r=[−0.33 to −0.44], P<0.05 with ΔESV) indicating that the increase of IP-10 at the acute phase of myocardial infarction confers a cardioprotective role. Multivariable linear regression analysis for ΔLVEF showed that in a model including baseline pre-reperfusion or 5min or 15min or 30min or 90min post-reperfusion IP-10 and age, gender, traditional risk factors (arterial hypertension, body-mass index, hyperlipoproteinemia, diabetes mellitus, smoking, family history of CAD), infarct location, admission high-sensitivity troponin T, door-to-balloon time and ciclosporin treatment, only IP-10 was the independent determinant of ΔLVEF. Conclusions Increased serum IP-10 levels early after reperfusion are associated with reverse LV remodeling in patients with STEMI undergoing primary PCI. The clinical application of IP-10 as a novel biomarker of LV remodeling post-AMI should be further explored and validated. Funding Acknowledgement Type of funding source: None

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