friedrich, j am coll cardiol 2008 tissue characterization of acute myocardial infarction and...
TRANSCRIPT
Friedrich, J Am Coll Cardiol 2008
Tissue characterization of acute myocardial infarction
and myocarditis by CMR
Matthias G. Friedrich
Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Inatitute of Alberta,
Departments of Cardiac Scienes and Radiology, University of Calgary, Calgary, AB, Canada
Friedrich, J Am Coll Cardiol 2008
Abstract
Friedrich, J Am Coll Cardiol 2008
Morphology Function Tissue Metabolism
Echo
Nuclear
CT
CMR
Figure 1 Strengths of currently used cardiac imaging tools
Friedrich, J Am Coll Cardiol 2008
Table 2Appearance of acute myocardial infarctions in CMR images
Friedrich, J Am Coll Cardiol 2008
Figure 2
EdemaEdemaEdemaEdema NecrosisNecrosisNecrosisNecrosis
Upper panel: Systolic
frame in a short axis view.
Lower panel: T2-weighted
(left) and post-contrast
T1-weighted ("late
enhancement") image
showing infarction-related
transmural edema, but
only subendocardial
necrosis.
CMR of
acute,
non-transmural
infarction Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure 3
EdemaEdemaEdemaEdema NecrosisNecrosisNecrosisNecrosis
Upper panel: Systolic
frame in a short axis view
with hypokinesis (arrows).
Lower panel: T2-weighted
(left) and post-contrast
T1-weighted ("late
enhancement") image
showing infarct-related
transmural edema with
transmural necrosis of the
same size.
CMR of
acute,
transmural
infarction
Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure 4
No-reflow/necrosisNo-reflow/necrosisNo-reflow/necrosisNo-reflow/necrosisNo-reflow/edemaNo-reflow/edemaNo-reflow/edemaNo-reflow/edema
Upper panel: Systolic frame
in a short axis view showing
preserved wall thickness of
the lateral wall, but regional
akinesis of the anterolateral
and inferolateral segments
(arrows).
Lower panel: T2-weighted
(left) and post-contrast T1-
weighted ("late
enhancement") images with
infarct-related transmural
edema and matching
necrosis in dysfunctional
area. Both, T2-weighted and
late enhancement images
show central no-reflow
(arrowheads).
CMR of acute, transmural infarction with no-reflow (late reperfusion)
Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure 5
ScarScarScarScarLack of edemaLack of edemaLack of edemaLack of edema
Upper panel: Systolic
frame in a short axis view
with akinesis of the
inferoseptal and inferior
segments (arrows).
Lower panel: T2-weighted
(left) and post-contrast T1-
weighted ("late
enhancement", right)
images showing no
edema, but transmural
fibrosis (arrows) within
the akinetic region.
CMR of ischemic cardiomyopathy with chronic, transmural inferior infarction
Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure 6
EdemaEdemaEdemaEdema NecrosisNecrosisNecrosisNecrosis
Upper panel: Systolic
frame of a cine study
showing pericardial
effusion (bright signa,
arrow) and largely
preserved systolic
function.
Lower panel: T2-weighted
(left) and post-contrast
T1-weighted ("late
enhancement", right)
images showing lateral
edema (arrows) and focal
fibrosis typical for the
non-ischemic injury
pattern of myocarditis
(arrows).
CMR of acute
myocarditis
Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure 7
EdemaEdemaEdemaEdema
No regional necrosisNo regional necrosisNo regional necrosisNo regional necrosisEarly enh./post contrastEarly enh./post contrastEarly enh./post contrastEarly enh./post contrast
CMR of a patient with acute myocarditis
Findings:
•Pathologic edema
ratio
•Pathologic early
enhancement
•No definite late
enhancement
Systolic frameSystolic frameSystolic frameSystolic frame
Friedrich, J Am Coll Cardiol 2008
Figure8
Systolic frameSystolic frameSystolic frameSystolic frame
EdemaEdemaEdemaEdema
Lateral scarLateral scarLateral scarLateral scarEarly enh./post contrastEarly enh./post contrastEarly enh./post contrastEarly enh./post contrast
Early enh./pre contrastEarly enh./pre contrastEarly enh./pre contrastEarly enh./pre contrast
CMR of a patient with acute myocarditis and chronic scar
Findings:
•Focal edema
•Pathologic early
enhancement
•Focal late
enhancement
Friedrich, J Am Coll Cardiol 2008
CMR of a patient with remote myocarditis
Chronic multifocal, partially subendocardial scarring (T1-weighted "late enhancement" image)
Figure 9
Friedrich, J Am Coll Cardiol 2008
Figure 10a
Systolic frameSystolic frameSystolic frameSystolic frame
EdemaEdemaEdemaEdema
Diffuse necrosisDiffuse necrosisDiffuse necrosisDiffuse necrosis
Tako-Tsubo - Admission
CMR of a patient with stress-induced CMP (Tako-Tsubo) - admission
Findings:
•Apical ballooning
•Regional edema
•Atypical late enhancement
Friedrich, J Am Coll Cardiol 2008
Figure 10 b
Systolic frameSystolic frameSystolic frameSystolic frame
EdemaEdemaEdemaEdema
Diffuse necrosisDiffuse necrosisDiffuse necrosisDiffuse necrosis
Tako-Tsubo - Follow-up
CMR of a patient with stress-induced CMP (Tako-Tsubo) – follow-up/4 wk
Findings:
•Normalizatioon of function
•No edema
•Some persisting late enhancement