Background: Sixty-four-slice multidetector spiral computed tomography ( CT) has improved temporal resolution and reduced acquisition time. We aimed to evaluate the functional analysis using 64-slice CT comparing with echocardiography, electrocardiographically gated single-photon emission tomography (SPECT) and cardiovascular magnetic resonance ( CMR).Methods: Six-three patients ( 77.4 +/- 18.6 bpm) underwent 64-slice CT and CMR ( echocardiography in 55; SPECT in 33) within 2 weeks were retrospectively reviewed. The left ventricular volumetric data from different methods were compared with CMR. Regional wall motion was compared between CT and CMR in a 17-segment and 4-point system (1=normal to 4=akinesis/dyskinesis).Results: Ejection fraction ( EF), end-diastolic volume ( EDV) and end-systolic volume (ESV) by CT agreed well with CMR ( bias +/- SD, -0.22% +/- 4.18, r=0.97;-0.59 mL +/- 15.21, r=0.98; 1.09 mL +/- 10.61, r=0.99) over a wide range of left ventricular ( LV) function ( EF 18-76% by CMR). Our results also showed good correlation of EF measured by CT and echocardiography ( r=0.87) or SPECT ( r=0.91, all P<0.0001); however, standard deviation of EF difference between CT and CMR was significantly less than echocardiography or SPECT ( P<0.005). For regional wall motion, an exact agreement of 97% (kappa=0.91) was found between CT and CMR.Conclusion: Sixty-four-slice CT agreed well with CMR in LV function assessment, and had a superior accuracy than echocardiography and SPECT on EF estimation. Sixty-four-slice CT is considered a clinically acceptable and robust method to evaluate LV function. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND The clinical features of patients with the dilated phase of hypertrophic cardiomyopathy (DHCM) may resemble those of patients with dilated cardiomyopathy (DCM); that is, systolic dysfunction and left ventricular dilatation. Myocardial flow reserve (MFR) is impaired in patients with nonischemic cardiomyopathy, and the reduced MFR may be related to poor prognosis. Several studies report that the mortality rate for patients with DHCM is higher than for DCM, but the difference between these 2 cardiomyopathies is still unclear. The purpose of this study was to assess the MFR of these 2 cardiomyopathies, using (15)O-water positron emission tomography (PET) to elucidate their differences. METHODS AND RESULTS In total 30 patients were investigated: 23 with DCM (Group A) and 7 with DHCM (Group B). All those who were in a stable condition underwent cardiac catheterization. Myocardial blood flow (MBF) at rest and under ATP infusion was measured by (15)O-water PET, and the MFR was calculated. There were no significant differences in the hemodynamics of the 2 groups. The mean MFR in DHCM was significantly lower than that in DCM (1.49+/-0.31 vs 2.62+/-1.08; p=0.042), whereas MBF at rest did not differ (DCM vs DHCM: 0.66+/-0.20 vs 0.49+/-0.05 ml . min(-1) . g(-1); NS). The MFR in both Group A and B was significantly decreased compared with the normal controls (MFR in normal controls: 5.15+/-1.64, p=0.00015, 0.00013, respectively). CONCLUSIONS These results suggest that impaired vasodilatation (ie, dysfunction of the microcirculation) is more severe in patients with DHCM than in patients with DCM, even though patients' characteristics and hemodynamics do not differ.

Malignant pleural mesothelioma (MPM) is an aggressive tumor that arises from the pleura and frequently extends to adjacent structures. MPM cells produce and respond to many angiogenic factors, such as vascular endothelial growth factor (VEGF). VEGF expression in MPM is correlated with microvascular density, which is associated with poor survival. CT has been widely used as the primary imaging modality for the clinical evaluation of MPM. Major findings include nodular pleural thickening, unilateral pleural effusion, and tumor invasion of adjacent structures. CT tends to underestimate early chest wall invasion and peritoneal involvement and has well-known limitations in the evaluation of lymph node metastases. Perfusion CT can evaluate the microvasculature of tumors, while its disadvantages, such as high radiation exposure or side effects from iodinated contrast, limit its use in both research and clinical settings. MRI can provide additional information to CT. Because of its excellent contrast resolution, MRI is superior to CT, both in the differentiation of malignant from benign pleural disease, and in the assessment of chest wall and diaphragmatic involvement. Perfusion MRI is the most promising technique for the assessment of the tumor microvasculature. In MPM, therapeutic effects of chemotherapy can be monitored with perfusion MRI. It has been shown that FDG-PET is useful for the differentiation of benign from malignant lesions, for staging and monitoring metabolic response to therapy against MPM, and that it has prognostic value. An initial report on PET/CT imaging of MPM has shown increased accuracy of overall staging, improving the assessment of tumor resectability. PET/CT seems to be superior to other imaging modalities in detecting more extensive disease involvement, and identifying unsuspected occult distant metastases.

Revascularization of viable myocardial segments has been shown to improve left ventricular (LV) function and long-term prognosis; however, the surgical risk is comparatively higher in patients with a low ejection fraction (EF). We compared contrast-enhanced MRI with 18F-FDG PET/201Tl SPECT for myocardial viability and prediction of early functional outcome in patients with chronic coronary artery disease (CAD). Methods: Forty-one patients with chronic CAD and LV dysfunction (mean age ± SD, 66 ± 10 y; 32 men; mean EF ± SD, 38% ± 13%) referred for 18F-FDG PET, 201Tl-SPECT and MRI within 2 wk were included. Twenty-nine subjects underwent coronary artery bypass grafting (CABG), and LV function was reassessed by MRI before discharge (17 ± 7 d after surgery). Two were excluded from outcome analysis (1 death due to sepsis; 1 perioperative myocardial infarction). The extent of viable myocardium by 18F-FDG PET/201Tl SPECT was defined by the metabolism–perfusion mismatch or ischemia, in comparison with the extent of delayed enhancement (DE) on MRI in a 17-segment model. Segmental functional recovery was defined as improvement in the wall motion score of ≥1 on a 4-point scale. EF and LV volume change were used as global functional outcome. Results: Three hundred ninety-four dysfunctional segments were compared, and the extent of DE on MRI correlated negatively with the viability on 18F-FDG PET. Of 252 dysfunctional segments that were successfully revascularized, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/SPECT were 60.2%, 98.7%, 76.6%, and 96.7% and of MRI were 92.2%, 44.9%, 72.4%, and 78.6% using the cutoff value of 50% DE on MRI, without significant differences in overall accuracies. In 18 subjects who underwent isolated CABG, improvement of EF (≥5%) and reverse LV remodeling (≥10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on 18F-FDG/SPECT predicted a poor early functional outcome (all P < 0.001). Conclusion: Accurate prediction of early functional outcome by PET/SPECT and contrast-enhanced MRI is possible.

Objective: To assess the influence of total injection volume on thoracic great vessels and coronary arteries enhancement in 64-detecter row computed tomography (CT) coronary angiography using low dose of contrast material. Methods: Sixty patients underwent cardiac CT (64 × 0.5 mm, 0.4 rot/s) using 40 mL of contrast material (350 mg of Iodine per milliliter) in 30 patients and 50 mL in 30 patients. Computed tomography densities (Hounsfield units) in ascending aorta, descending aorta, and main pulmonary artery were measured at every second with the time of CT data acquisition recorded in each reconstructed image. Computed tomography densities of proximal and distal coronary arteries were also measured. Differences in CT densities between 40 and 50 mL contrast material were assessed with the Student t test. In addition, the relation between the injection volume (mL) of contrast material per kilogram body weight and contrast enhancement in coronary arteries was studied. Results: The average attenuations in the ascending and descending aorta and coronary arteries were significantly lower in 40-mL group than in 50-mL group (<0.05). In addition, the average attenuations in the pulmonary artery were significantly lower in 40-mL group than 50-mL group (<0.01). Every patient with the total injection volume of more than 0.9 mL/kg body weight showed a contrast enhancement more than 250 Hounsfield units. Conclusions: The reduction of total injection volume lowered the enhancement of thoracic great vessels and coronary arteries in 64-detector row cardiac CT. The injection volume of at least 0.9 mL/kg body weight was necessary for a steady contrast enhancement in coronary arteries.

Objective: To compare the quality of multidetector-row computed tomographic angiography in patients with and without aortic aneurysms by 3 different amounts of contrast media (CM). Methods: A total of 115 patients with aortic aneurysms were divided into 3 groups: group A, 100 mL CM; group B, 75 mL CM with 20 mL saline flush (SF); and group C, 50 mL CM with 20 mL SF. Twenty-five patients without aortic aneurysms were also enrolled (group D, 50 mL CM with 20 mL SF). Quantitative and qualitative analyses were performed by measuring attenuation in thoracoabdominal/aortoiliac lumen, aneurysmal lumen, and superior vena cava. Results: In group C, attenuation was lower in distal than those in proximal and middle areas (P < 0.05). Contrast enhancement in abdominal aneurysmal lumen was more inhomogeneous in group C (P = 0.003). Visual analysis showed contrast enhancement was more nonuniform in group C (P = 0.004), and perivenous artifacts were more conspicuous in group A (P < 0.0001). Conclusions: Seventy-five milliliters CM followed by 20 mL SF can produce optimal contrast enhancement at systemic multidetector-row computed tomographic angiography in patients with aortic aneurysms.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an uncommon inheritable cardiomyopathy involving predominant right ventricle with progressive fibrofatty tissue replacement. An integrated assessment of electrical, functional and anatomic abnormalities, in addition to personal and family history would be used to diagnose this disease entity. We present the case of a 69-year-old man with a history of sustained ventricular tachycardia. Fatty infiltration and regional wall motion abnormalities over biventricular myocardium were clearly demonstrated by cardiac 64-slice computed tomography (CT), as consistent with magnetic resonance imaging. Thus, multi-slice CT may have a significant role in the assessment and follow-up of patients with ARVD/C by providing excellent structural, functional assessment and tissue characterization.

The aim of this study was to assess the value of contrast-enhanced cardiovascular magnetic resonance (CMR) in viability for patients with coronary artery disease and left ventricular (LV) dysfunction (ejection fraction [EF] ≤50%), comparing to gated thallium-201 (201Tl) single photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET).

Sarcoidosis is a non-caseating granulomatous systemic disease of unknown pathogenesis, and cardiac involvement is the most important prognostic factor. We have evaluated the value of the combined study of F-18 fluoro-2-deoxyglucose positron emission tomography and iodine-123 labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid single-photon emission tomography for the assessment of cardiac involvement of sarcoidosis, by comparing the findings with gadolinium magnetic resonance in a patient with histologically-proven cardiac sarcoidosis.

The aim of this study was to assess the accuracy of cardiac functional values obtained from free-breathing real-time cine CMR with the temporal sensitivity encoding (TSENSE) technique by comparing them with values obtained from conventional cine CMR. For the real-time cine CMR, two protocols were employed, one with good temporal resolution and one with good spatial resolution. The functional values obtained from the high temporal resolution real-time cine CMR agreed and correlated well with those of cine CMR. On the other hand, statistically significant but clinically slight overestimation of ESV (p < .05) and underestimation of EF (p < .01) were observed with the other protocol. Real-time cine CMR with TSENSE can provide acceptable cardiac functional values.

Objective: The progress in computed tomography (CT) has improved temporal resolution and shortened the acquisition time. We compared cardiac function using 64-slice CT with left ventriculography (LVG) and cardiovascular magnetic resonance (CMR). Methods: A head-to-head comparison between CT, LVG and CMR was performed in 41 patients. In global LV function, CMR served as the reference. Regional wall motion was compared in a 5-point scoring system. Results: CT had excellent intra- and interobserver reproducibility. Ejection fraction, end-diastolic and end-systolic volumes by CT were closely correlated with CMR (r = 0.95, 0.96 and 0.98, respectively), while LVG underestimated LV volumes (p < 0.01). The standard deviation of ejection fraction difference between CT and CMR was significantly lower than that between LVG and CMR (p = 0.0015). In regional function, there were good agreements of 94.8% (ĸ = 0.82) between CT and LVG and 94.5% (ĸ = 0.84) between CT and CMR. The intermethod agreements in mild hypokinesis using CT tended to be lower. Conclusion: An excellent correlation was observed between CT and CMR in the LV function over a wide range of heart rates. However, even though 64-slice CT tended to be less sensitive in detecting mild hypokinesis, it still showed excellent concordance in advanced regional abnormalities.

OBJECTIVE:The objective of our study was to compare the image quality of MDCT angiography studies obtained by injection of low doses of contrast medium with saline flush versus conventional doses of contrast medium. MATERIALS AND METHODS:Seventy-one patients with pre- or postoperative aortic aneurysms underwent MDCT angiography throughout the thoracoabdominal-aortoiliac system using an 8-MDCT scanner. In 37 patients, 100 mL of contrast medium was injected at a flow rate of 3.0 mL/s (hereafter referred to as the 100-mL group). In 34 patients, 50 mL of contrast medium followed by a 20-mL saline flush was injected at a flow rate of 2.5 mL/s (the 50-mL group). For each group, quantitative analysis involved calculating the mean aortoiliac enhancement, plateau deviation, and contrast enhancement in the pulmonary trunk and superior vena cava (SVC). Qualitative analysis involved assessing the 3D postprocessing images. RESULTS:Significant differences between the groups in mean aortoiliac enhancement (100-mL group vs 50-mL group, 337 +/- 6 H vs 319 +/- 5 H, p < 0.0001) and mean plateau deviation (51 +/- 4 H vs 58 +/- 4 H, p < 0.0001) were found. However, adequate arterial enhancement (>or= 200 H) was observed in 31 of 34 patients in the 50-mL group and uniform aortoiliac enhancement (< 50 H) was seen in 26 patients. Visual analysis showed no difference in contrast material magnitude and homogeneity between the groups. Furthermore, in the 50-mL group, the thoracic aorta was more clearly visualized because of a reduction in the opacity of the main pulmonary artery and SVC. CONCLUSION:In our experience, administration of 50 mL of contrast medium followed by a 20-mL saline flush produces thoracoabdominal-aortoiliac MDCT angiographic examinations of effective quality in most cases.

HomeCirculationVol. 113, No. 20Multimodality Imaging of Cardiac Sarcoidosis Before and After Steroid Therapy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBMultimodality Imaging of Cardiac Sarcoidosis Before and After Steroid Therapy Eiji Tadamura, MD, PhD, Masaki Yamamuro, MD, Shigeto Kubo, MD, PhD, Shotaro Kanao, MD, Ryohei Hosokawa, MD, PhD, Takeshi Kimura, MD, PhD, Toru Kita, MD, PhD and Kaori Togashi, MD, PhD Eiji TadamuraEiji Tadamura From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Masaki YamamuroMasaki Yamamuro From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Shigeto KuboShigeto Kubo From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Shotaro KanaoShotaro Kanao From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Ryohei HosokawaRyohei Hosokawa From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Takeshi KimuraTakeshi Kimura From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author , Toru KitaToru Kita From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author and Kaori TogashiKaori Togashi From the Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (E.T., M.Y., S. Kubo, S. Kanao, K.T.); and the Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan (R.H., T. Kimura, T. Kita). Search for more papers by this author Originally published23 May 2006https://doi.org/10.1161/CIRCULATIONAHA.105.594200Circulation. 2006;113:e771–e773A 65-year-old woman was referred to our hospital because of chest pain. Right ventricular bundle-block was noted on the ECG. Angiotensin-converting enzyme level was elevated (33.2 IU/L). Delayed-enhanced magnetic resonance imaging (MRI) using an inversion-recovery segmented gradient echo sequence performed 15 minutes after gadolinium contrast injection (0.15 mmol/kg of gadodiamide) disclosed hyperenhancement, mainly in the outer layer of the septal, inferior, and anterolateral walls (Figure 1A). Cine MRI revealed wall motion abnormalities in septal and inferior walls (Figure 1B and 1C; Movie I). Left ventricular ejection fraction was 44%. Resting 201thallium single photon emission tomography revealed perfusion defects in these walls (Figure 1D). Positron emission tomography with 18fluorodeoxyglucose (FDG PET) imaging performed in a fasting condition showed FDG accumulation in the septal, inferior, and anterolateral walls, corresponding to areas with late enhancement (Figure 1E). Whole-body FDG PET imaging depicted significant FDG uptake not only in the heart but also in the hilar, mediastinal, and cervical lymph nodes (Figure 2, Movie II, left). Cardiac involvement of sarcoidosis was confirmed by histological analysis of endomyocardial biopsy. After 6 months of steroid therapy, her angiotensin-converting enzyme level was decreased (13.1 IU/L). Areas with delayed enhancement were markedly diminished (Figure 3A). Wall motion abnormalities (Figure 3B and 3C; Movie III) and perfusion abnormalities (Figure 3D) in the septal and inferior walls were not significantly changed. Her left ventricular ejection fraction was 41%. FDG accumulation was surprisingly decreased in the heart and lymph nodes (Figure 4, Movie II, right). Download figureDownload PowerPointFigure 1. A short-axis image of delayed-enhanced MRI reveals severe extent of hyperenhancement in septal, inferior, and anterolateral regions (white arrows). B and C, Cine MRI obtained at end diastole (B) and end systole (C) in a basal short-axis slice show wall motion abnormalities in septal and inferior walls (black arrows). Also see Movie I. D, A short-axis image of 201thallium single photon emission tomography demonstrates perfusion defects in septal and inferior regions (white arrows), where severe extent of enhancement is seen in a delayed enhanced MR image. E, A short-axis image of fasting FDG PET shows FDG accumulation in septal, inferior, and anterolateral walls (white arrows), corresponding to areas with late enhancement.Download figureDownload PowerPointFigure 2. Whole-body FDG PET image in a fasting condition shows striking FDG accumulation in the hilar, mediastinal, and cervical lymph nodes and the heart. Also see Movie II, left.Download figureDownload PowerPointFigure 3. A, Areas of hyperenhancement in the septal, inferior, and anterolateral regions are considerably decreased after steroid therapy (white arrows). B and C, Cine MRI obtained at end diastole (B) and end systole (C) in a short-axis slice show wall motion abnormalities even after steroid therapy (black arrows). Also see Move III. D, 201Thallium perfusion defects in septal and inferior walls (white arrows) are not significantly improved after steroid therapy.Download figureDownload PowerPointFigure 4. Whole-body FDG PET image in a fasting condition shows the marked reduction of FDG uptake in the heart and lymph nodes after steroid therapy. Also see Movie II, right.Before steroid therapy, areas with hyperenhancement in the delayed-enhanced images corresponded to the areas with decreased 201thallium defects, increased FDG uptake, and wall motion abnormalities. Thus, delayed enhancement in contrast-enhanced MRI is considered to reflect fibrogranulomatous tissues of sarcoidosis replacing the normal myocardium. The number of areas with late enhancement and FDG uptake in the heart was surprisingly decreased after the suppression of the disease activities by the steroid therapy, whereas wall motion abnormalities were not significantly improved. The pathophysiological condition of cardiac sarcoidosis has been clearly identified by multimodality imaging.The online-only Data Supplement, which contains 3 movies, is available at http://circ.ahajournals.org/cgi/content/full/113/20/e771/DC1.FootnotesCorrespondence to Eiji Tadamura, MD, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara, Sakyo-ku, Kyoto, 606-8507, Japan. 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Blauwet L and Cooper L (2012) Idiopathic giant cell myocarditis and cardiac sarcoidosis, Heart Failure Reviews, 10.1007/s10741-012-9358-3, 18:6, (733-746), Online publication date: 1-Nov-2013. Martínez-Rodríguez I and Carril J (2013) Update on the use of PET radiopharmaceuticals in inflammatory disease, Revista Española de Medicina Nuclear e Imagen Molecular (English Edition), 10.1016/j.remnie.2013.09.005, 32:6, (378-386), Online publication date: 1-Nov-2013. Nakano S, Kimura F, Osman N, Sugi K, Tanno J, Uchida Y, Shiono A, Senbonmatsu T and Nishimura S (2013) Improved Myocardial Strain Measured by Strain-Encoded Magnetic Resonance Imaging in a Patient With Cardiac Sarcoidosis, Canadian Journal of Cardiology, 10.1016/j.cjca.2013.02.023, 29:11, (1531.e9-1531.e11), Online publication date: 1-Nov-2013. UCHIDA M, SHINOHARA T, TAKAHASHI N and SAIKAWA T (2011) Interventricular Septal Mass in a Patient with Cardiac Sarcoidosis, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2011.02227.x, 23:4, (433-435), Online publication date: 1-Apr-2012. Schuller J, Lowery C, Zipse M, Aleong R, Varosy P, Weinberger H and Sauer W (2011) Diagnostic Utility of Signal-Averaged Electrocardiography for Detection of Cardiac Sarcoidosis, Annals of Noninvasive Electrocardiology, 10.1111/j.1542-474X.2010.00411.x, 16:1, (70-76), Online publication date: 1-Jan-2011. Morgenthau A and Iannuzzi M (2011) Recent Advances in Sarcoidosis, Chest, 10.1378/chest.10-0188, 139:1, (174-182), Online publication date: 1-Jan-2011. From A, Maleszewski J and Rihal C (2011) Current Status of Endomyocardial Biopsy, Mayo Clinic Proceedings, 10.4065/mcp.2011.0296, 86:11, (1095-1102), Online publication date: 1-Nov-2011. Ohira H, Tsujino I and Yoshinaga K (2011) 18F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis, European Journal of Nuclear Medicine and Molecular Imaging, 10.1007/s00259-011-1832-y, 38:9, (1773-1783), Online publication date: 1-Sep-2011. Ohira H, Tsujino I, Sato T, Yoshinaga K, Manabe O, Oyama N and Nishimura M (2011) Early Detection of Cardiac Sarcoid Lesions with 18F-fluoro-2-deoxyglucose Positron Emission Tomography, Internal Medicine, 10.2169/internalmedicine.50.4813, 50:11, (1207-1209), . Nomura S, Funabashi N, Tsubura M, Uehara M, Shiina Y, Daimon M, Tateno K, Nagai T and Komuro I (2011) Cardiac sarcoidosis evaluated by multimodality imaging, International Journal of Cardiology, 10.1016/j.ijcard.2009.11.027, 150:2, (e81-e84), Online publication date: 1-Jul-2011. SCHULLER J, OLSON M, ZIPSE M, SCHNEIDER P, ALEONG R, WIENBERGER H, VAROSY P and SAUER W (2011) Electrocardiographic Characteristics in Patients With Pulmonary Sarcoidosis Indicating Cardiac Involvement, Journal of Cardiovascular Electrophysiology, 10.1111/j.1540-8167.2011.02099.x, 22:11, (1243-1248), Online publication date: 1-Nov-2011. Khan R, Tweedie E, Pflugfelder P and White J (2010) Cardiac Sarcoid in a Heart Transplant Recipient: Detection With Cardiac Magnetic Resonance Imaging, Transplantation Proceedings, 10.1016/j.transproceed.2010.01.066, 42:5, (1976-1978), Online publication date: 1-Jun-2010. Kim J, Judson M, Donnino R, Gold M, Cooper L, Prystowsky E and Prystowsky S (2009) Cardiac sarcoidosis, American Heart Journal, 10.1016/j.ahj.2008.09.009, 157:1, (9-21), Online publication date: 1-Jan-2009. Niida T, Isoda K, Sasaki M, Horikawa M, Hayashi K and Ohsuzu F (2009) Late Gadolinium Enhanced High Resolution Magnetic Resonance Imaging Reveals Pathophysiological Condition of Cardiac Sarcoidosis, International Heart Journal, 10.1536/ihj.50.263, 50:2, (263-266), . Ohira H, Tsujino I, Ishimaru S, Oyama N, Takei T, Tsukamoto E, Miura M, Sakaue S, Tamaki N and Nishimura M (2007) Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis, European Journal of Nuclear Medicine and Molecular Imaging, 10.1007/s00259-007-0650-8, 35:5, (933-941), Online publication date: 1-May-2008. Matoh F, Satoh H, Shiraki K, Odagiri K, Saitoh T, Urushida T, Katoh H, Takehara Y, Sakahara H and Hayashi H (2008) The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis, Journal of Cardiology, 10.1016/j.jjcc.2008.03.002, 51:3, (179-188), Online publication date: 1-Jun-2008. Silva C, Moon J and Pennell D (2007) Progressive myocardial scarring from sarcoidosis, Journal of Cardiovascular Medicine, 10.2459/01.JCM.0000269719.18188.ae, 8:6, (468-469), Online publication date: 1-Jun-2007. Bucciarelli-Ducci C, Locca D, O'Hanlon R, Oldershaw P and Prasad S (2007) Severely impaired left ventricular function: Tissue characterization by cardiovascular magnetic resonance in a clinical dilemma, European Journal of Heart Failure, 10.1016/j.ejheart.2007.06.002, 9:9, (959-961), Online publication date: 1-Sep-2007. Sozzi F, Iacuzio L, Belmonte M, Schiavone M, Bursi F, Gherbesi E, Levy F, Canetta C and Carugo S (2022) Early diagnosis of cardiomyopathies by cardiac magnetic resonance. Overview of the main criteria, Monaldi Archives for Chest Disease, 10.4081/monaldi.2022.2151 May 23, 2006Vol 113, Issue 20 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.594200PMID: 16717157 Originally publishedMay 23, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)Nuclear Cardiology and PETTreatment

HomeCirculationVol. 113, No. 7Hibernating Myocardium Identified by Cardiovascular Magnetic Resonance and Positron Emission Tomography Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBHibernating Myocardium Identified by Cardiovascular Magnetic Resonance and Positron Emission Tomography Eiji Tadamura, MD, PhD, Masaki Yamamuro, MD, Shigeto Kubo, MD, PhD, Shotaro Kanao, MD, Masaki Harada, MD, PhD, Kazuwa Nakao, MD, PhD, Masashi Komeda, MD, PhD and Kaori Togashi, MD, PhD Eiji TadamuraEiji Tadamura From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Masaki YamamuroMasaki Yamamuro From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Shigeto KuboShigeto Kubo From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Shotaro KanaoShotaro Kanao From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Masaki HaradaMasaki Harada From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Kazuwa NakaoKazuwa Nakao From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author , Masashi KomedaMasashi Komeda From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author and Kaori TogashiKaori Togashi From the Department of Diagnostic Imaging and Nuclear Medicine (E.T., M.Y., S. Kubo, S. Kanao, K.T.), the Department of Medicine and Clinical Science (M.H., K.N.), and the Department of Cardiovascular Surgery (M.K.), Kyoto University Graduate School of Medicine, Kyoto, Japan. Search for more papers by this author Originally published21 Feb 2006https://doi.org/10.1161/CIRCULATIONAHA.105.563130Circulation. 2006;113:e158–e159A 72-year-old woman was admitted with chest pain. On ECG, abnormal Q wave was noted in leads II, III, aVF, V1, and V2. Coronary angiography revealed occluded right and left anterior descending coronary arteries. Collateral vessels were observed from the left circumflex coronary artery to the right coronary artery.Dynamic first-pass magnetic resonance (MR) perfusion imaging was performed in a resting condition, using 0.075 mmol/kg gadodiamide (Gd DTPA-BMA) and saturation-recovery gradient echo sequence. Fifteen minutes after a 0.15 mmol/kg dose of Gd DTPA-BMA was injected, delayed-enhanced MR images were acquired through the use of an inversion-recovery segmented gradient echo sequence. Additionally, cine MR images were acquired with the use of a segmented true fast imaging with steady-state precession sequence. Perfusion deficit was noted in the subendocardial layer of septal and inferior walls (Figure 1A and Figure 2A; Movie I and Movie II), whereas no evident delayed hyperenhancement was observed (Figure 1B and Figure 2B). This suggests that severe myocardial hypoperfusion in a resting condition is present without myocardial infarction. By thallium-201 single-photon emission tomography at rest (Figure 1C and Figure 2C) and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) (Figure 1D and Figure 2D), enhanced FDG uptake was clearly noted in the hypoperfused segments. Thus, the hypoperfused myocardium was suggested to be the ischemic but viable myocardium. In cine MRI, wall thinning and a marked decrease in wall thickening was observed in these segments (Figure 1E and 1F and Figure 2E and 2F; Movie III, left, and Movie IV, left). Her left ventricular ejection fraction was 42%. Based on these results, the left internal thoracic artery was grafted onto to the left anterior descending artery and the left gastroepiploic artery onto the posterior descending artery. One month after the bypass operation, significantly improved wall thickness and wall thickening was observed in the septal and inferior walls by cine MRI (Figure 1G and 1H, and Figure 2G and 2H; Movie III, right, and Movie IV, right). Left ventricular ejection fraction increased to 56%. Download figureDownload PowerPointFigure 1. Short axis. A, MR first-pass perfusion image at rest; B, delayed-enhanced MR image; C, thallium image at rest; D, FDG PET image. E and F, end-diastolic and end-systolic images of cine MRI from the preoperative MR scan; G and H, those from the postoperative MR scan. Resting subendocardial ischemia (A, black arrows) is noted in the septal and inferior walls without late hyperenhancement (B). Hypoperfusion is also noted on resting thallium single-photon emission tomography in the septal and inferior walls (C, white arrows). In these regions, enhanced FDG uptake is observed (D, white arrows), suggesting the ischemic but viable myocardium. Note the myocardial wall thinning in the septal and inferior walls (E, F) and the reduced myocardial thickening in these regions (F, black arrows). After coronary artery bypass grafting, the myocardial wall thickness and systolic wall thickening improves markedly in these segments (G, H).Download figureDownload PowerPointFigure 2. Vertical long axis. A, MR first-pass perfusion image at rest; B, delayed-enhanced MR image; C, thallium image at rest; D, FDG PET image. E and F, end-diastolic and end-systolic images of cine MRI from the preoperative MR scan; G and H, those from the postoperative MR scan. Resting subendocardial ischemia (A, black arrows) is noted in the septal wall without late hyperenhancement (B). Hypoperfusion is also noted on resting thallium single-photon emission tomography in the septal wall (C, white arrows). In this region, enhanced FDG uptake is observed (D, white arrows), suggesting the ischemic but viable myocardium. Note the myocardial wall thinning in the septal wall (E, F) and the reduced myocardial thickening in this region (F, black arrows). After coronary artery bypass grafting, the myocardial wall thickness and systolic wall thickening improves markedly in this segment (G, H).Rahimtoola1 first proposed the pathophysiological concept of myocardial hibernation to characterize a situation of a prolonged subacute or chronic state of myocardial ischemia in which myocardial contractility, ventricular function, and metabolism are changed to match the reduced blood supply whereby myocardial necrosis is prevented, and the myocardium is capable of returning to normal or near-normal function on restoration of an adequate blood supply. This case is considered a typical example of myocardial hibernation. The pathophysiological status of the hibernating myocardium has been demonstrated by multimodality imaging.The online-only Data Supplement, which contains Movie I through Movie IV, can be found at http://circ.ahajournals.org/cgi/content/full/ 113/7/e158/DC1.FootnotesCorrespondence to Eiji Tadamura, MD, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara, Sakyo-ku, Kyoto, 606-8507, Japan. E-mail [email protected]Reference1 Rahimtoola SH. A perspective on the three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina. Circulation. 1985; 72 (suppl V): V-123–V-135.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Mangrum W, Bashir M, Merkle E, Song A and Paldino M (2012) Perfusion Magnetic Resonance Imaging Duke Review of MRI Principles, 10.1016/B978-1-4557-0084-4.00015-2, (229-247), . Chatterjee K (2010) Is Detection of Hibernating Myocardium Necessary in Deciding Revascularization in Systolic Heart Failure?, The American Journal of Cardiology, 10.1016/j.amjcard.2010.02.034, 106:2, (236-242), Online publication date: 1-Jul-2010. February 21, 2006Vol 113, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.563130PMID: 16490827 Originally publishedFebruary 21, 2006 PDF download Advertisement SubjectsChronic Ischemic Heart DiseaseComputerized Tomography (CT)Nuclear Cardiology and PET

Purpose: To evaluate the influence of heart rate (HR) on magnetic resonance coronary angiography (MRCA) image quality in diastolic and systolic phases.Materials and methods: Twenty-seven healthy volunteers (9 men; 33 +/- 9 years, HR 53-110 bpm), were evaluated with the electrocardiography and three-dimensional navigator-gating MRCA in a 1.5-T MR scanner (Avanto, Siemens) in diastolic and systolic phases (steady-state free precession; TR/TE/flip angle = 3.2 ms/1.6 ms/90 degrees). The timing of scanning was individually adapted to the cardiac rest periods obtained in the prescanning, by visually identifying when the movement of right coronary artery was minimized during diastole and systole. Images of two phases were side-by-side compared on a four-point scale (from 1 = poor to 4 = excellent visibility; score of 3 or 4 as diagnostic).Results: Of 13 subjects with HR <= 65 bpm (low HR group, mean 59.8 +/- 4.9 bpm, range 53-65), the image quality scores were significantly better than that with higher heart rates (73.9 +/- 9.0 bpm, range 68-110) in diastolic MRCA. The image quality was significantly improved during systole in high HR group. Overall, 91.3% of low HR group had MRCA image of diagnostic quality acquired at diastole, while 88.3% of high HR group had diagnostic images at systole by segmental analysis (p = NS).Conclusions: MRCA at systole offered superior quality in patients with high heart rates. (C) 2006 Elsevier Ireland Ltd. All rights reserved.

Lipomatous metaplasia of myocardium after myocardial infarction (MI) is less reported, and the exact prevalence and clinical implications of this phenomenon are unclear. A case of lipomatous metaplasia after MI evaluated with cardiovascular magnetic resonance (CMR) and computed tomography (CT) is presented. The presence of lipomatous metaplasia could not be easily differentiated from scar simply by the delayed-enhanced images. Loss of signal on TrueFISP cine MRI can be a hint. A pre-contrast T1-weighted image with or without frequency-selective fat suppression is useful in order to verify the existence of lipomatous metaplasia on CMR.

Delayed-enhanced magnetic resonance (MR) imaging has recently been shown to be effective in detecting cardiac sarcoidosis. Two cases in which contrast-enhanced multislice computed tomography imaging clearly identified the localization and extension of cardiac sarcoidosis as delayed-enhanced MR imaging are presented.