A Pattern-based Approach to Assessment of Delayed Enhancement in Nonischemic Cardiomyopathy at MR Imaging

Cummings, Kristopher W.; Bhalla, Sanjeev; Javidan-Nejad, Cylen; Bierhals, Andrew J.; Gutiérrez, Fernando R.; Woodard, Pamela K.

doi:10.1148/rg.291085052

Cited by 195 publications

(122 citation statements)

References 29 publications

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“…Contrary to that septal involvement was hardly seen in our study [1,16] , which might reflect different underling etiologies of DCM (e.g. alcohol, drug intoxication).…”

Section: Discussioncontrasting

confidence: 99%

“…Interestingly, a midmyocardial streaky or spotty LGE localized basal or lateral was linked to HCM in our study and no preferred septal involvement was seen, which was reported by others before [1,11,17,18] . Again, differentiation from peri-/myocarditis was most sensitive by signal intensity, which was considerably weaker in HCM.…”

Section: Discussionsupporting

confidence: 83%

“…Through these studies some patterns were identified that were related to certain non-ischemic disorders [1][2][3][4][5] . The aim of our study was to provide a structured approach in LGE analysis, which might be helpful in confining and arriving at the correct diagnosis, enabling appropriate treatment of non-ischemic diseases, thereby possibly reducing morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Due to robust technical features of the hardware and further software developments, the diagnostic potential and capabilities of CMR constantly broaden. Besides functional analysis and the assessment of the extent of viable and non-viable myocardium CMR has been increasingly appreciated in diagnosing and monitoring non-ischemic myocardial disease such as myocarditis or cardiomyopathy [1,2] and is also known to play an important role with regard to prediction of adverse cardiac outcomes [3] .…”

Section: Introductionmentioning

confidence: 99%

“…Late gadolinium enhancement (LGE) is a substantial part of CMR and is highly valued in both differentiating between ischemic and non-ischemic myocardial disease as shown by various studies [1][2][3][4][5][6][7][8][9][10][11] as well as identifying primary or secondary cardiomyopathy. LGE uses extracellular paramagnetic, Gadolinium-based contrast agents and reflects edema, myocyte necrosis or fibrosis of different etiologies.…”

Section: Introductionmentioning

confidence: 99%

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Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Heilmaier

Franzen

Naßenstein

et al. 2014

IJDI

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Objective: Value of late gadolinium enhancement (LGE) in diagnosis of ischemic disorders in cardiac magnetic resonance is well-known. The purpose of the present paper was to describe more details and characteristics of LGE patterns arising in several non-ischemic myocardial diseases. Methods:Cardiac MRI was performed in 1,905 patients at a 1.5-T MR system and showed LGE with 1,646/1,905 demonstrating LGE patterns or other diagnostic criteria (e.g. laboratory results, ECG, coronary angiography findings) regarded typical for ischemic heart disease. The remaining 259/1,905 patients revealed LGE related to non-ischemic myocardial disease. Two experts (radiologists and/or cardiologist) qualitatively described LGE pattern in consensus reading with regard to its site (left or right ventricle), extent (subendocardial, midmyocardial, subepicardial, transmural, pericardial), segment (according to the 17-segment model of left ventricle (LV)), distribution (streaky, patchy, punctual, spotty, crescent, diffuse), and intensity (weak, moderate, strong). Thereafter, results were correlated to final diagnosis based on synopsis of clinical features, laboratory results, ECG, biopsy, or other imaging procedures. Results:In 250/259 patients (96.5%) only the LV was affected by LGE, most frequently midmyocardial (166/259). In most cases this was due to peri-/myocarditis (especially if of weak-moderate intensity), while a weaker, streaky or spotty LGE basal or lateral pointed to HCM (39/166) and streaky and lateral to DCM (20/166). A midmyocardial, patchy LGE in segment 3 and 5 was caused by Fabry's disease (6x). In case of a transmural, spotty or patchy pattern LGE pointed to HCM, if intensity was weak-moderate, or to peri-/myocarditis, when LGE was moderate-strong. In addition to that, subepicardial LGE in basal segments with patchy, streaky, or spotty distribution and moderate intensity was also due to peri-/myocarditis, while it was located midventricular, spotty and weak in TASH (transcoronary ablation of septum hypertrophy). Conclusions: SeveralLGE patterns point to certain non-ischemic myocardial diseases and thereby might facilitate and confine differential diagnosis and might be useful in biopsy planing.

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“…Contrary to that septal involvement was hardly seen in our study [1,16] , which might reflect different underling etiologies of DCM (e.g. alcohol, drug intoxication).…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Heilmaier

Franzen

Naßenstein

et al. 2014

IJDI

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Therapeutic implications of a combined diagnostic workup including endomyocardial biopsy in an all‐comer population of patients with heart failure: a retrospective analysis

et al. 2018

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BackgroundAetiology of heart failure (HF) often remains obscure. We therefore evaluated the usefulness of a combined diagnostic approach including cardiac magnetic resonance imaging (CMRI) and endomyocardial biopsy (EMB) to assess the cause of unexplained cardiomyopathy underlying HF.Methods and resultsWe retrospectively investigated 100 consecutive patients (36% women, mean age 53.6 ± 18.8 years) presenting with unexplained cardiomyopathy (HF with reduced ejection fraction or left ventricular hypertrophy; excluding ischaemic and valvular heart disease; left ventricular ejection fraction 31.6 ± 13.9%, Left ventricular end‐diastolic pressure 18.2 ± 9.3 mmHg, heart rate 89 ± 26.6 b.p.m.; mean ± SEM) at the University Medical Center Mainz. We performed electrocardiography, echocardiography, CMRI, and cardiac catheterization with EMB analysed at a Food and Drug Administration‐approved reference centre in 100%, 94%, 69%, and 100% of patients, respectively. On the basis of CMRI findings, electrocardiography, echocardiography, and medical history, the exact cause of cardiomyopathy remained uncertain in 37 of 69 cases (53.6%). In EMB, 25% of patients had viral replication, 23% had inflammation defined as lymphocytic infiltrations without active virus replication, 1% had giant cell myocarditis, and 1% had eosinophilic myocarditis. After diagnostic workup including EMB findings, the cause of cardiomyopathy remained unidentified in 14% of the cases, classified as idiopathic dilated cardiomyopathy or hypertrophic cardiomyopathy in 10% or 4%, respectively. EMB helped to discuss a causal treatment strategy of HF involving immunosuppression or antiviral treatment in 53% of patients, which was opted for in 12% of the patients.ConclusionsA comprehensive workup including imaging and EMB in an all‐comer population of patients with HF may help physicians to improve diagnostics of unexplained cardiomyopathy in the majority of cases.

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Noninvasive imaging in cardiac deposition diseases

Shah

Nucifora

Perry

et al. 2017

Magnetic Resonance Imaging

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Infiltrative cardiomyopathy represents a heterogeneous group of diseases of the heart tissue with similar phenotypic expression. The condition is rare, but can be easily mistaken for other more common conditions of the heart. The diagnosis of infiltrative cardiomyopathy is therefore challenging and has often required the use of invasive procedures in the past. In the last decade there have been great advances in non‐invasive cardiac imaging modalities like echocardiography, cardiovascular magnetic resonance and nuclear imaging. Although no single imaging modality abnormality on its own is pathognomic for infiltrative cardiomyopathy, a combination of these different modalities are synergistic, and can greatly aid in the clinical diagnosis. In this review, we describe these advancements in non‐invasive cardiac imaging modalities with a particular focus on cardiovascular magnetic resonance imaging. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:44–59.

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A Pattern-based Approach to Assessment of Delayed Enhancement in Nonischemic Cardiomyopathy at MR Imaging

Cited by 195 publications

References 29 publications

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Therapeutic implications of a combined diagnostic workup including endomyocardial biopsy in an all‐comer population of patients with heart failure: a retrospective analysis

Noninvasive imaging in cardiac deposition diseases

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