Abstract 18297: Clinical and Prognostic Utility of Cardiac Magnetic Resonance Imaging in Multiple Myeloma Patients With Suspected Amyloidosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sabha Bhatti ◽  
Evan Watts ◽  
Fahd Syed ◽  
Abdul Hakeem
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Cardiac Mri ◽  
Cardiac Amyloidosis ◽  
Cardiac Involvement ◽  
Al Amyloidosis ◽  
Resonance Imaging ◽  
Prognostic Utility

Background: Upto 30% of patients with multiple myeloma have AL amyloidosis and cardiac involvement is associated with worse outcomes in these patients. Traditional screening modalities including EKG, echocardiography and biomarkers have limited value. The aim of this study was to evaluate the role of “screening” cardiac MRI in a large multiple myeloma population at a large specialized referral center. Methods & Results: 164 consecutive patients with multiple myeloma who underwent cardiac MRI between 6/2005 and 10/2011 were enrolled in this study. Primary endpoint was all cause death. Clinical, EKG, echocardiographic, biomarker and MRI predictors for death were analyzed. Mean age of population was 63+10 years, 40% females and 16% African Americans. 30% of the population had MRI evidence of cardiac involvement. There were 26 patients who had biopsy proven systemic amyloidosis, of whom 62% showed cardiac involvement on MRI. 81% patients with confirmed cardiac amyloidosis on endomyocardial biopsy had typical MR pattern of cardiac involvement. During a median follow up period of 702 days (mean 1019 (950) days), there were 59 deaths (36%). Amyloid pattern on cardiac MRI (OR 2.19), elevated BNP and increased LV wall thickness on MRI were significant predictors of mortality . (All p<0.05) Conclusions: This is the largest study to date evaluating the role of cardiac MRI in multiple myeloma patients with suspected cardiac amyloidosis. Cardiac MRI is a clinically robust tool for risk stratification of this subset of patients.

scholarly journals Role of cardiac MRI in the diagnosis of cardiac amyloidosis. Clinical cases

2021 ◽  
Vol 2 (2) ◽  
pp. 16-20
Author(s):  
Ekaterina A. Butorov ◽  
◽  
Olga V. Stukalova ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Cardiac Mri ◽  
Cardiac Amyloidosis ◽  
Resonance Imaging ◽  
Gadolinium Enhancement ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Cases

Purpose. The aim of this work is to show the capabilities of late gadolinium enhancement cardiac magnetic resonance imaging (MRI) in the diagnosis of a rare disease such as cardiac amyloidosis. Materials and methods. Demonstration of clinical cases detecting cardiac amyloidosis using MRI. Results. Contrast-enhanced cardiac MRI revealed patterns characteristic of cardiac amyloidosis. Conclusion. Cardiac MRI with late gadloinium enhancement is the method of choice in the diagnosis of cardiac amyloidosis.

The Role of Whole-Body Magnetic Resonance Imaging in the Staging and Follow-Up of Bone Disease in Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5063-5063
Author(s):  
M. Varettoni ◽  
F. Calliada ◽  
P. Zappasodi ◽  
P. Arcuti ◽  
S. Mangiacavalli ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Myeloma ◽  
Biochemical Markers ◽  
Field Of View ◽  
Whole Body ◽  
Bone Lesions ◽  
Resonance Imaging ◽  
Lytic Lesions

Abstract Radiographic skeletal survey (RSS) is the standard diagnostic tool for the screening of bone lesions in multiple myeloma (MM) at diagnosis and during the course of disease. Its major limitation is the low sensitivity in detecting minimal bone lesions and in differentiating active from inactive osteolyses. Several studies demonstrated the superiority of magnetic resonance imaging (MRI) over RSS for the detection of spinal and pelvis bone lesions. However, a significant proportion of patients develops bone lesions elsewhere, therefore MRI of spine and pelvis is inadequate for the staging and follow-up of patients. Recently, whole-body MRI (WB-MRI) has been used with promising results for the detection of secondary bone lesions in patients with non-haematological malignancies. The aims of this study were to evaluate the potential role of WB-MRI in the staging and follow-up of MM patients, using RSS as a standard of reference, and to study the correlation of MRI findings with biochemical markers of bone turnover. Characteristics of the 9 patients included in the study were the following: median age 57 years (46–67), 6 males and 3 females; 4 patients were untreated and asymptomatic, and 5 previously treated with chemotherapy. On the same day, all patients underwent RSS and WB-MRI, and blood sampling for serum osteocalcin (OC) as a marker of bone formation, and for carboxyterminal telopeptide of type I collagen (ICTP) as a marker of bone resorption. RSS and WB-MRI were read by two independent radiologists. WB-MRI was performed with a 1.5-T scanner (Magnetom Symphony Maestro Class). The skull, thorax, pelvis, femoral and lower leg bones were imaged in coronal planes, while sagittal images of the spine were acquired. T1-weighted spinecho (SE) and short-tau inversion time inversion recovery (STIR) sequences (TR 2670, TE 101, TI 150) with a maximum field of view of 450 mm and slice thickness of 5 mm were obtained. As reference standard contrast-enhanced MRI was performed in patients with discordant data at RSS and WB-MRI. RSS was negative in 5 patients, whereas in 4 revealed lytic lesions stable with respect to prior controls. In the group of RSS-negative patients, WB-MRI was positive in 3/5 cases, 2 of whom had marrow and serum progression at the time of evaluation. All 4 RSS-positive patients showed lytic lesions also at WB-MRI with an overlapping pattern of distribution. Only the lesions at humeral bones were not detected by WB-MRI, because humeri are outside the field of view. WB-MRI, however, was superior to RSS in identifying lytic lesions in the spine and pelvis. Biochemical markers of bone metabolism were evaluable in 8/9 cases. ICTP levels were high only in one patient without evidence of bone lesions both at RSS and WB-MRI. OC levels were low in 6 of 8 evaluable patients, and 5 of them had a positive WB-MRI. In conclusion, WB-MRI seems more sensitive than RSS for the detection of bone lesions in MM patients. In particular, it is more suitable for the initial staging of the disease in asymptomatic stage I MM and for the follow-up of patients with a stable picture of lytic lesions at RSS. There is no correlation between ICTP levels and the radiological findings, whereas OC levels are decreased in patients with extensive bone involvement.

scholarly journals Follow-up magnetic resonance imaging of Löffler endocarditis: a case report

2020 ◽  
Author(s):  
Shinya Ito ◽  
Akihiro Isotani ◽  
Kyohei Yamaji ◽  
Kenji Ando
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Corticosteroid Therapy ◽  
Cardiac Mri ◽  
High Intensity ◽  
Left Ventricular ◽  
Eosinophil Infiltration ◽  
Resonance Imaging ◽  
T2 Weighted Images

Abstract Background  Löffler endocarditis is a condition characterized by cardiac infiltration of eosinophils. Cardiac magnetic resonance imaging (MRI) is a modality for the diagnosis of myocardial damage. Case summary  This is the case of a 77-year-old man with acute decompensated heart failure who was admitted. Transthoracic echocardiography showed preserved left ventricular (LV) systolic function along with LV thrombi attached to the septo-apical wall and the posterior wall, consistent with Löffler endocarditis. Cardiac MRI revealed obliteration of the LV apex and partial filling of the LV cavity, as well as near circumferential subendocardial late gadolinium enhancement (LGE) in the mid- and apical segments. T2-weighted images showed a near circumferential high-intensity area of the LV subendocardial muscle in the mid- and apical segments. High-dose corticosteroids and intravenous heparin were initiated, followed by maintenance warfarin therapy. At 18 months, follow-up cardiac MRI revealed the disappearance of the LV thrombi, and a reduction of LGE, as well as high-intensity areas in the T2-weighted images. Discussion  The high-intensity area of T2-weighted images indicate the presence of subendocardial oedema. Eosinophil-mediated heart damage evolves through three stages: (i) acute necrotic, (ii) thrombotic, and (iii) fibrotic stages. Since the deposition of toxic eosinophil granule proteins and eosinophil infiltration injured the endocardium, the first-line treatment for Löffler endocarditis is corticosteroid therapy. In this case, LGE in the subendocardium and the high-intensity area in the T2-weighted images were reduced at 18 months. High-intensity areas of T2-weighted images in the acute phase might indicate the possibility of therapeutic response to corticosteroid therapy.

scholarly journals Heart arrhythmias and conduction disorders in patients with acromegaly: the role of cardiac magnetic resonance imaging

2020 ◽  
Vol 92 (10) ◽  
pp. 70-77
Author(s):  
K. V. Melkozerov ◽  
E. G. Przhiyalkovskaya ◽  
N. V. Tarbaeva ◽  
A. A. Almaskhanova ◽  
M. D. Kuklina ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Cardiac Mri ◽  
Somatostatin Analogs ◽  
Cardiac Conduction ◽  
Resonance Imaging ◽  
Functional Changes ◽  
Conduction Disorders

Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored. Aim.To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes. Materials and methods.A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast. Results.The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia 19.1% of the cases and conduction disorders of bundle branch blocks 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively,p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didnt undergo this therapy (50% and 38.6% respectively,p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04). Conclusion.Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the gold standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.

Adjunctive role of preoperative liver magnetic resonance imaging added to computed tomography among resected pancreatic cancer patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 207-207
Author(s):  
Hyoung Woo Kim ◽  
Jin-Hyeok Hwang ◽  
Jong-chan Lee ◽  
Kyu-hyun Paik ◽  
Jingu Kang ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Hepatic Metastases ◽  
Resonance Imaging ◽  
Liver Mri ◽  
Hepatic Recurrence ◽  
Liver Magnetic Resonance Imaging ◽  
Hepatic Lesions

207 Background: Multi-detector computed tomography using pancreatic protocol (pCT) has been a preferred diagnostic imaging modality before resection of the pancreatic ductal adenocarcinoma (PDAC), because an adjunctive role of liver magnetic resonance imaging (MRI) is still unclear. The current study evaluated whether liver MRI added to pCT can help to select proper surgical candidates, and reduce the risk of early recurrence, eventually result in longer survival in resected PDAC patients. Methods: Among 197 PDAC patients who underwent curative-intended surgery, 167 patients who achieved complete resection with no grossly visible tumor were enrolled retrospectively. All patients had no metastatic lesions on pCT and/or MRI, preoperatively. Among them, 102 patients underwent pCT alone (CT group), and 65 patients liver MRI as well as pCT (MRI group). Results: By adding the liver MRI, hepatic metastases were newly discovered in 3 of 58 patients (5.2%) with no hepatic lesions on pCT and in 17 of 53 patients (32.1%) with indeterminate hepatic lesions on pCT. Among 167 patients who achieved R0/R1 resection, the median overall and disease-free survival were 20.1 vs 29.3 months and 8.5 vs 10.0 months in the CT and the MRI group, respectively (p = 0.011 and = 0.012), during median follow-up of 16.4 months. 80 (78.4%) patients in the CT group and 39 (60.0%) in the MRI group experienced recurrence during follow-up. Cumulative initial hepatic recurrence rate was higher in the CT group than in the MRI group (43.7% vs 18.5% at 1yr and 57.4% vs 26.9% at 2yr, p < 0.001), although the other sites recurrence did not differ in both groups. Conclusions: Liver MRI added to pCT has an incremental value in detecting PDAC hepatic metastases. Furthermore, because PDAC patients who underwent resection after liver MRI as well as pCT expect lower rate of hepatic recurrence and better survival than pCT alone, therefore, liver MRI added to pCT is needed to patients who planned curative resection of PDAC.

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