T2‐weighted cardiovascular magnetic resonance imaging

Abdel-Aty, Hassan; Simonetti, Orlando P.; Friedrich, Matthias G.

doi:10.1002/jmri.21028

Cited by 199 publications

(162 citation statements)

References 63 publications

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“…Therefore, CMRI including T 2 weighted imaging, late-post gadolinium T 1 weighted acquisitions and cines should be performed in symptomatic patients suspected of having IL-2 induced myocarditis. T 2 weighted imaging can identify and quantify myocardial oedema [8]. The distribution of high T 2 signal in myocarditis can be sub-epicardial, transmural, global or patchy.…”

Section: Discussionmentioning

confidence: 99%

Fulminant myocarditis owing to high-dose interleukin-2 therapy for metastatic melanoma

Thavendiranathan¹,

Verhaert²,

Kendra³

et al. 2011

BJR

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ABSTRACT. High-dose interleukin-2 (IL-2) therapy may cause acute myocarditis characterised by diffuse myocardial involvement and occasionally fulminant heart failure. Cardiac MRI (CMRI) provides a comprehensive assessment of myocardial function, inflammation and injury in a single examination and has shown value in the diagnosis of myocarditis. We report a case of a 54-year-old male with metastatic melanoma who developed acute severe myocarditis with fulminant heart failure after high-dose IL-2 therapy. CMRI using a combination of T 2 weighted imaging and T 1 weighted late postgadolinium enhancement techniques played a key role in establishing the diagnosis. To our knowledge we present the first case report of the combined use of T 1 and T 2 weighted CMRI techniques to diagnose IL-2 induced myocarditis.

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Section: Discussionmentioning

confidence: 99%

Fulminant myocarditis owing to high-dose interleukin-2 therapy for metastatic melanoma

Thavendiranathan¹,

Verhaert²,

Kendra³

et al. 2011

BJR

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“…We did not quantify the extent of myocardial edema from T2W images, nor did we quantify infarct size beyond LGE score. However, this approach is usually based on qualitative or semiquantitative analyses that rely on signal intensity relative to another tissue such as skeletal muscle that, too, may be abnormal 28, 29…”

Section: Discussionmentioning

confidence: 99%

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Cardona

Zaręba

Nagaraja

et al. 2018

JAHA

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BackgroundT‐wave abnormalities are common during the acute phase of non‐ST‐segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T‐wave abnormalities in the presentation of non‐ST‐segment elevation acute coronary syndromes correspond to the presence of myocardial edema.Methods and ResultsSecondary analysis of a previously enrolled prospective cohort of patients presenting with non‐ST‐segment elevation acute coronary syndromes was conducted. Twelve‐lead electrocardiography (ECG) and cardiac magnetic resonance with T2‐weighted imaging were acquired before invasive coronary angiography. ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST‐ or T‐wave abnormalities, isolated T‐wave abnormality, isolated ST depression, ST depression+T‐wave abnormality. Myocardial edema was determined by expert review of T2‐weighted images. Of 86 subjects (65% male, 59.4 years), 36 showed normal/nonischemic ECG, 25 isolated T‐wave abnormalities, 11 isolated ST depression, and 14 ST depression+T‐wave abnormality. Of 30 edema‐negative subjects, 24 (80%) had normal/nonischemic ECGs. Isolated T‐wave abnormality was significantly more prevalent in edema‐positive versus edema‐negative subjects (41.1% versus 6.7%, P=0.001). By multivariate analysis, an ischemic ECG showed a strong association with myocardial edema (odds ratio 12.23, 95% confidence interval 3.65‐40.94, P<0.0001). Among individual ECG profiles, isolated T‐wave abnormality was the single strongest predictor of myocardial edema (odds ratio 23.84, 95% confidence interval 4.30‐132, P<0.0001). Isolated T‐wave abnormality was highly specific (93%) but insensitive (43%) for detecting myocardial edema.ConclusionsT‐wave abnormalities in the setting of non‐ST‐segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.

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“…DIRT may find use as a fat saturation alternative for MR angiography and for the identification of lipid pathology such as lipomas and fatty infiltration of the right ventricle (19). Fluid or edema imaging is often performed using long echo time turbo-spin-echo imaging (20,21). The advantages of the DIRT technique can only be gleaned by direct comparison with existing techniques, which has not been performed in this paper.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance separation imaging using a divided inversion recovery technique (DIRT)

Goldfarb

2010

Magn. Reson. Med.

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The divided inversion recovery technique is an MRI separation method based on tissue T 1 relaxation differences. When tissue T 1 relaxation times are longer than the time between inversion pulses in a segmented inversion recovery pulse sequence, longitudinal magnetization does not pass through the null point. Prior to additional inversion pulses, longitudinal magnetization may have an opposite polarity. Spatial displacement of tissues in inversion recovery balanced steadystate free-precession imaging has been shown to be due to this magnetization phase change resulting from incomplete magnetization recovery. In this paper, it is shown how this phase change can be used to provide image separation. A pulse sequence parameter, the time between inversion pulses (T180), can be adjusted to provide water-fat or fluid separation. Example water-fat and fluid separation images of the head, heart, and abdomen are presented. The water-fat separation performance was investigated by comparing image intensities in short-axis divided inversion recovery technique images of the heart. Fat, blood, and fluid signal was suppressed to the background noise level. Additionally, the separation performance was not affected by main magnetic field inhomogeneities. Magn Reson Med 63:1007-1014, 2010. V C 2010 Wiley-Liss, Inc. Key words: MRI; separation imaging; fat; lipid; fluid; myocardial infarction; pulse sequence; inversion recovery; bSSFP Tissue characterization in MRI is mostly performed using a visual assessment of image contrast generated by contrast agents or intrinsic magnetic relaxation time differences. MR images with pixel intensities weighted by T 1 or T 2 relaxation times are most commonly used. Additionally, preparation pulses can generate a variety of image contrasts between tissues. For example, fat saturation (1), magnetization transfer contrast radiofrequency pulses (2), or diffusion gradient pulses (3) may be added to impose specific image contrasts. The difference in pixel intensities allows identification of and discrimination between diseased and healthy tissues using a single image.MR image separation techniques provide multiple images of the same imaging plane with pixels separated by an intrinsic tissue parameter. Water-fat separation (4) provides two images. Pixels composed primarily of lipids are displayed in the fat image and the other pixels composed primarily of water are displayed in the second image. Water-fat separation is most commonly performed using the chemical shift between water and fat nuclei. Image separation can also be performed using other parameters such as T 1 relaxation times or T 1 -weighted imaging pixel intensity (5). In T 1 -weighted spoiled gradient echo images, fat usually has the brightest signal and water-fat separation can be performed using a simple image intensity threshold.Recently, an artifact was identified during late gadolinium-enhanced myocardial infarct imaging using an inversion recovery balanced steady-state free precession (IR-bSSFP) technique (6,7). This artifact is a spa...

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T2‐weighted cardiovascular magnetic resonance imaging

Cited by 199 publications

References 63 publications

Fulminant myocarditis owing to high-dose interleukin-2 therapy for metastatic melanoma

Fulminant myocarditis owing to high-dose interleukin-2 therapy for metastatic melanoma

T‐Wave Abnormality as Electrocardiographic Signature of Myocardial Edema in Non‐ST‐Elevation Acute Coronary Syndromes

Magnetic resonance separation imaging using a divided inversion recovery technique (DIRT)

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