SlideShare ist ein Scribd-Unternehmen logo
1 von 26
Downloaden Sie, um offline zu lesen
Cardiac MRI for ischemic heart
disease
Dr.Abhijeet Bhambure
Junior Resident
Radio-diagnosis dept.
KIMS, Karad.
• INTRODUCTION: Leading cause of mortality and morbidity in developed
counteries. Estimated will be leading cause of death till end of this decade.
First attack> high risk of death d/t complication related.
• Emerging imaging modalities CCT and CMR for IHD and coronary heart ds.
• PATHOPHYSIOLOGY:
- CAD (A.plaque) mcc >IHD
- Chronic stable : slow plaque obcstruction
- If plaque ruptures > thrombus > acute coronary syndrome (fig)
- Therapeutic current: PCI and thrombolysis t/t
- Myocardial infarctions are usually classified by (a)location (anterior, inferior,
lateral), (b) size (focal necrosis,small (<10%), moderate (10–30%) and large
(>30%of LV myocardium) and (c) temporally as evolving (<6 h),acute (6 h–7
days), healing (7–28 days) and healed (>28days).
- healing process can result to thinning of the wall resulting to remodelling and
finally causing dilated type cardiomyopathy.
- Stunned vs hibernating myocardium? > acute reperfusion injury (generally
occurs within hours of reperfusion) causing contractility dysfunction which
takes days to become normal – stunned. Takes years (chronic form) to regain
normal function – hibernating m.
CARDIAC MRI IN ISCHEMIC HEART DISEASES
CARDIAC MRI IN ISCHEMIC HEART DISEASES
CARDIAC MRI IN ISCHEMIC HEART DISEASES
CORONARY ANGIOGRAPHY
• Coronary MR angiography is at present still not
incorporated in daily clinical care, mainly
because of long acquisition times, unreliable
image quality and the availability and ease of
use of CCT. However, clinically interesting
indications for coronary MR angiography are
imaging of congenital anomalies of the coronary
arteries, coronary artery imaging in
(postoperative) patients with congenital heart
disease and diagnosis (and follow-up) of patients
with coronary aneurysms in Kawasaki’s disease
CARDIAC MRI IN ISCHEMIC HEART DISEASES
CARDIAC MRI IN ISCHEMIC HEART DISEASES
FUNCTIONAL IMAGING
- imp for the IHD workup
esp. for post MI with
remodelling changes.
Includes: echo, CMRI, CCT,
nuclear study, SPECT and
angiographic studies.
White blood Imaging
• gradient echo sequences and steady-state free precession MRI (SSFP).
• The main advantage of white blood imaging is its fast acquisition. It can obtain movement
sequences and allows studying cardiac function and movement. CINE can find volumes in
chambers.
PERFUSION STUDY:
- Using contrast like gadolinium. perfusion across the myocardium is studied. (STRESS TEST can be
usde in perfusion detection where adenosine <beta agonist> is given for the stress on myocardium). Its
first pass contrast.
LGE is late gadolinium enhancement. done after 10-25min of the contrast administration.
• Dark blood Imaging- on spin echo or steady-state free precession sequences -These can be
T1, T2, or proton density weighted sequences - T1 weighted sequences achieve better
anatomic definition and T2 and PD weighted sequences reach better tissue characterization
MYOCARDIAL INFARCTION IMAGING
CASES:
73/F Cine stress MRI shows perfusion defect along anterolateral myocardial wall predominantly in
subendocardial region. On cartherization 70% stenosis was noted then PCI was done.
Importance of stress MRI which
find out the perfusion defect
region suggesting chronic stable
CAD.
microvascular obstruction (MVO) –
lack of tissue perfusions (its seen
inearly post contrast) as contrast not
diffused.
rest can be normal, here on stress MRI showing persisent myodcardial perfusion defect. it was post
CABG case in 70m post x increasing chest pain non relieved on medicines. surgical intervention was
planned.
T2 SA HLA bright – edema
(excess water content or in
short myocardium at risk). T
with STIR is commonly done
to find out the edema
LGE corresponds to edema
suggests irreversible damage
to the tissue. (non salvagable)
Lcx branch.
T2 edema-bright LGE infarction with pericardial inflammation.
LGE is not reliable indicator of necrosis in acute setting.
T2 shows bright-edema
with central dark core.
first pass contrast shows
main microvascular
obstruction (MVO) – lack
of tissue perfusions (its
seen inearly post
contrast) as contrast not
diffused.
on early and late contrast
the darker area appear
reduced suggesting the
diffusion of GD into the
necrotic part.
on cine (end diastolic and
end systolic) shows
inferolateral wall shows
impaired contraction.
additional now T2 dark
could reflect the
hemorrhage. Cine even
shows bright signal
pericardium s/o effusion/
inflammation. the blood in
T2 will be heterogenous
ie peripheral hyperintense
rim
MYOCARDIAL VIABILITY IMAGING
Post contrast enhancement with occlusion. CINE end systolic early and late (6month) shows mardked
thinning of the myocardium.
following such remodelling revascularition can help. but revascularition would only help in viable, stunned
and hybernated myocardium and not necrotic/scarred myocardium. here comes role of CMR to find out the
viable myocardium
Viability imaging in 57-year-
old patient presenting
ischaemic cardiomyopathy
and increasing dyspnoea
CINE showing increased
volume, reduced EF, severe
thinning. LGE shows
transmural enhancment
suggesting healed
myocardial infarction (non
viable)
thinning of <6mm even has
low chances of reversibility
(done in end diaslolic)
transmural enhancement in
the inferolateral wall
reflecting a healed
extensive
inferolateral myocardial
infarction - irreversible
damage
CINE image shows posterior
myocardial wall shows
thinning with reduced EF
and increased chamber
volume.
On LGE shows transmural
enhancement suggesting
MI. on confirmation by
angiography shows RCA
occlusion.
POST MI COMPLICATIONS
- Ventricular thrombus common complication associated with ischemic dilated cardimyopathy. common
after anterior wall MI.
- actually contrast study for CMR is bonus thing as we do it for the detection of MI so can incidentally find i
- to differentiate between the myocardial occlusion and intraluminal - for intramyocardial there will be no
reflow on late contrast images.
- CMR also shows incidentally the presence of pericardial inflammation (this are common association
with transmural type of infarction) as we seen in earlier cases could be pericardiatis or pericardial
effusion.
- aneurysms
first pass post contrast
(inversioin images)
shows transmuaral non
enhancement. but on
LGE shows endocardial
non late enhancement
with altered signal and
looking at VLA view
shows altered signal
suggesting presence of
mural thrombus in
presence of MI
CINE - myocardial hypo and thinnin. on early and late contrast shows transmural enhancement and hypointense
thrombus with apex aneurysm
CMR at 1 wk and after 4months – shows edema them thinning. Subendocardial no reflow and transmural
enhancment. Papillary muscles shows no reflow.
DIFFERENTIAL SIMILAR TO MI on imaging
T2 edema. post contrast in all view shows epicardial and subepicardial enhancement suggesting acute
pericarditis. this was case of 17 F with retrosternal pain on BX pericardium lyphohistiocytic infiltrates were noted.
T2 WI shows edema in left lateral wall. On LGE enhancement noted mainly in subepicardial region. Its acute
myocarditis in 18yr female.
CINE and T1 shows hyperintense mass. on LGE shows non enhancing mass with myocardial wall enhancement
hyper on T1 and hypo LGE suggests myocaradial hematoma with scarring of the adjacent myocardium - case of
post traum to chest in 71m
THANK YOU!

Weitere ähnliche Inhalte

Was ist angesagt?

Cardiac MRI
Cardiac MRICardiac MRI
Cardiac MRIaravazhi
 
Myocardial perfusion scintigraphy overview
Myocardial perfusion scintigraphy overviewMyocardial perfusion scintigraphy overview
Myocardial perfusion scintigraphy overviewMostafa Sayed
 
Ct calcium scoring 1
Ct calcium scoring 1Ct calcium scoring 1
Ct calcium scoring 1Sahar Gamal
 
Imaging in renal transplant
Imaging in renal transplantImaging in renal transplant
Imaging in renal transplantalma dsouza
 
Doppler ultrasound of the portal system - Normal findings
Doppler ultrasound of the portal system - Normal findingsDoppler ultrasound of the portal system - Normal findings
Doppler ultrasound of the portal system - Normal findingsSamir Haffar
 
radiology Spotters mixed bag
radiology Spotters mixed bagradiology Spotters mixed bag
radiology Spotters mixed bagAnish Choudhary
 
Retroperitoneal masses radiology
Retroperitoneal masses radiologyRetroperitoneal masses radiology
Retroperitoneal masses radiologyDr. Mohit Goel
 
State-of-the-art Cardiac CT of the coronary arteries
State-of-the-art Cardiac CT of the coronary arteriesState-of-the-art Cardiac CT of the coronary arteries
State-of-the-art Cardiac CT of the coronary arteriesErik R. Ranschaert, MD, PhD
 
Ct coronary angiography edited 1st
Ct   coronary  angiography edited 1stCt   coronary  angiography edited 1st
Ct coronary angiography edited 1stYashawant Yadav
 
CT Angiography presentation
CT Angiography presentation CT Angiography presentation
CT Angiography presentation Shatha M
 
Coronary ct angiography
Coronary ct angiographyCoronary ct angiography
Coronary ct angiographySGPGI, lucknow
 
Imaging neurology spotters
Imaging   neurology spottersImaging   neurology spotters
Imaging neurology spottersNeurologyKota
 
Peripheral arterial doppler
Peripheral  arterial dopplerPeripheral  arterial doppler
Peripheral arterial dopplerAnish Choudhary
 

Was ist angesagt? (20)

Cardiac MRI
Cardiac MRICardiac MRI
Cardiac MRI
 
Radiology spotters
Radiology spottersRadiology spotters
Radiology spotters
 
Cardiac MRI
Cardiac MRICardiac MRI
Cardiac MRI
 
Radiology Spotters
Radiology Spotters Radiology Spotters
Radiology Spotters
 
CT Angiography Lower Limb
CT Angiography Lower LimbCT Angiography Lower Limb
CT Angiography Lower Limb
 
Myocardial perfusion scintigraphy overview
Myocardial perfusion scintigraphy overviewMyocardial perfusion scintigraphy overview
Myocardial perfusion scintigraphy overview
 
MR imaging of liver
MR imaging of liverMR imaging of liver
MR imaging of liver
 
Ct calcium scoring 1
Ct calcium scoring 1Ct calcium scoring 1
Ct calcium scoring 1
 
Imaging in renal transplant
Imaging in renal transplantImaging in renal transplant
Imaging in renal transplant
 
Doppler ultrasound of the portal system - Normal findings
Doppler ultrasound of the portal system - Normal findingsDoppler ultrasound of the portal system - Normal findings
Doppler ultrasound of the portal system - Normal findings
 
radiology Spotters mixed bag
radiology Spotters mixed bagradiology Spotters mixed bag
radiology Spotters mixed bag
 
Retroperitoneal masses radiology
Retroperitoneal masses radiologyRetroperitoneal masses radiology
Retroperitoneal masses radiology
 
Cardiac MRI
Cardiac MRICardiac MRI
Cardiac MRI
 
State-of-the-art Cardiac CT of the coronary arteries
State-of-the-art Cardiac CT of the coronary arteriesState-of-the-art Cardiac CT of the coronary arteries
State-of-the-art Cardiac CT of the coronary arteries
 
Ct coronary angiography edited 1st
Ct   coronary  angiography edited 1stCt   coronary  angiography edited 1st
Ct coronary angiography edited 1st
 
CT Angiography presentation
CT Angiography presentation CT Angiography presentation
CT Angiography presentation
 
Spots with keys
Spots with keysSpots with keys
Spots with keys
 
Coronary ct angiography
Coronary ct angiographyCoronary ct angiography
Coronary ct angiography
 
Imaging neurology spotters
Imaging   neurology spottersImaging   neurology spotters
Imaging neurology spotters
 
Peripheral arterial doppler
Peripheral  arterial dopplerPeripheral  arterial doppler
Peripheral arterial doppler
 

Ähnlich wie CARDIAC MRI IN ISCHEMIC HEART DISEASES

Imaging of acute stroke , Interventions
Imaging of acute stroke  , InterventionsImaging of acute stroke  , Interventions
Imaging of acute stroke , InterventionsArif S
 
CARDIAC MRI braunwalds 2.pptx
CARDIAC MRI braunwalds 2.pptxCARDIAC MRI braunwalds 2.pptx
CARDIAC MRI braunwalds 2.pptxdara213127
 
Presentation1.pptx, radiological imaging of cerebral ischemia.
Presentation1.pptx, radiological imaging of cerebral ischemia.Presentation1.pptx, radiological imaging of cerebral ischemia.
Presentation1.pptx, radiological imaging of cerebral ischemia.Abdellah Nazeer
 
COMMON POSITIVE BRAIN SCANS.pptx
COMMON POSITIVE BRAIN SCANS.pptxCOMMON POSITIVE BRAIN SCANS.pptx
COMMON POSITIVE BRAIN SCANS.pptxDr vaibhavi patel
 
Imaging in stroke
Imaging in stroke Imaging in stroke
Imaging in stroke Deepak Garg
 
Imaging ischemic infarction.pptx
Imaging ischemic infarction.pptxImaging ischemic infarction.pptx
Imaging ischemic infarction.pptxirkoWorku
 
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdf
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdfInterpretation of Clinical Lab Data [CARDIAC] for newbies.pdf
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdfsamthamby79
 
Imaging in stroke
Imaging in strokeImaging in stroke
Imaging in strokeRaju Soni
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction vani
 
11111801_Myocardial_infarction.ppt
11111801_Myocardial_infarction.ppt11111801_Myocardial_infarction.ppt
11111801_Myocardial_infarction.pptssuser4a6ed4
 
Imaging in stroke
Imaging in strokeImaging in stroke
Imaging in strokeIndhu Reddy
 
Cerebral Infarcts . pptx
Cerebral Infarcts          .         pptxCerebral Infarcts          .         pptx
Cerebral Infarcts . pptxDr Abna J
 

Ähnlich wie CARDIAC MRI IN ISCHEMIC HEART DISEASES (20)

Imaging of acute stroke , Interventions
Imaging of acute stroke  , InterventionsImaging of acute stroke  , Interventions
Imaging of acute stroke , Interventions
 
CARDIAC MRI braunwalds 2.pptx
CARDIAC MRI braunwalds 2.pptxCARDIAC MRI braunwalds 2.pptx
CARDIAC MRI braunwalds 2.pptx
 
Presentation1.pptx, radiological imaging of cerebral ischemia.
Presentation1.pptx, radiological imaging of cerebral ischemia.Presentation1.pptx, radiological imaging of cerebral ischemia.
Presentation1.pptx, radiological imaging of cerebral ischemia.
 
Imaging in acute stroke
Imaging in acute strokeImaging in acute stroke
Imaging in acute stroke
 
COMMON POSITIVE BRAIN SCANS.pptx
COMMON POSITIVE BRAIN SCANS.pptxCOMMON POSITIVE BRAIN SCANS.pptx
COMMON POSITIVE BRAIN SCANS.pptx
 
Brain MRI
Brain MRIBrain MRI
Brain MRI
 
Imaging in stroke
Imaging in stroke Imaging in stroke
Imaging in stroke
 
Imaging ischemic infarction.pptx
Imaging ischemic infarction.pptxImaging ischemic infarction.pptx
Imaging ischemic infarction.pptx
 
Neuroradiology 1a
Neuroradiology 1a Neuroradiology 1a
Neuroradiology 1a
 
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdf
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdfInterpretation of Clinical Lab Data [CARDIAC] for newbies.pdf
Interpretation of Clinical Lab Data [CARDIAC] for newbies.pdf
 
NO REFLOW
NO REFLOWNO REFLOW
NO REFLOW
 
Imaging in stroke
Imaging in strokeImaging in stroke
Imaging in stroke
 
Myocardial infarction
Myocardial infarction Myocardial infarction
Myocardial infarction
 
MRI in CVA
MRI in CVAMRI in CVA
MRI in CVA
 
STEMI-LEO.pptx
STEMI-LEO.pptxSTEMI-LEO.pptx
STEMI-LEO.pptx
 
Cardiac MRI
Cardiac MRICardiac MRI
Cardiac MRI
 
Cortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptx
Cortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptxCortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptx
Cortical cerebral venous thrombosis (CVT) Management- Dr Ganesh.pptx
 
11111801_Myocardial_infarction.ppt
11111801_Myocardial_infarction.ppt11111801_Myocardial_infarction.ppt
11111801_Myocardial_infarction.ppt
 
Imaging in stroke
Imaging in strokeImaging in stroke
Imaging in stroke
 
Cerebral Infarcts . pptx
Cerebral Infarcts          .         pptxCerebral Infarcts          .         pptx
Cerebral Infarcts . pptx
 

Kürzlich hochgeladen

EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfMedicoseAcademics
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...bkling
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 

Kürzlich hochgeladen (20)

EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Pregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdfPregnacny, Parturition, and Lactation.pdf
Pregnacny, Parturition, and Lactation.pdf
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
Moving Forward After Uterine Cancer Treatment: Surveillance Strategies, Testi...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 

CARDIAC MRI IN ISCHEMIC HEART DISEASES

  • 1. Cardiac MRI for ischemic heart disease Dr.Abhijeet Bhambure Junior Resident Radio-diagnosis dept. KIMS, Karad.
  • 2. • INTRODUCTION: Leading cause of mortality and morbidity in developed counteries. Estimated will be leading cause of death till end of this decade. First attack> high risk of death d/t complication related. • Emerging imaging modalities CCT and CMR for IHD and coronary heart ds. • PATHOPHYSIOLOGY: - CAD (A.plaque) mcc >IHD - Chronic stable : slow plaque obcstruction - If plaque ruptures > thrombus > acute coronary syndrome (fig) - Therapeutic current: PCI and thrombolysis t/t - Myocardial infarctions are usually classified by (a)location (anterior, inferior, lateral), (b) size (focal necrosis,small (<10%), moderate (10–30%) and large (>30%of LV myocardium) and (c) temporally as evolving (<6 h),acute (6 h–7 days), healing (7–28 days) and healed (>28days). - healing process can result to thinning of the wall resulting to remodelling and finally causing dilated type cardiomyopathy. - Stunned vs hibernating myocardium? > acute reperfusion injury (generally occurs within hours of reperfusion) causing contractility dysfunction which takes days to become normal – stunned. Takes years (chronic form) to regain normal function – hibernating m.
  • 6. CORONARY ANGIOGRAPHY • Coronary MR angiography is at present still not incorporated in daily clinical care, mainly because of long acquisition times, unreliable image quality and the availability and ease of use of CCT. However, clinically interesting indications for coronary MR angiography are imaging of congenital anomalies of the coronary arteries, coronary artery imaging in (postoperative) patients with congenital heart disease and diagnosis (and follow-up) of patients with coronary aneurysms in Kawasaki’s disease
  • 9. FUNCTIONAL IMAGING - imp for the IHD workup esp. for post MI with remodelling changes. Includes: echo, CMRI, CCT, nuclear study, SPECT and angiographic studies.
  • 10. White blood Imaging • gradient echo sequences and steady-state free precession MRI (SSFP). • The main advantage of white blood imaging is its fast acquisition. It can obtain movement sequences and allows studying cardiac function and movement. CINE can find volumes in chambers. PERFUSION STUDY: - Using contrast like gadolinium. perfusion across the myocardium is studied. (STRESS TEST can be usde in perfusion detection where adenosine <beta agonist> is given for the stress on myocardium). Its first pass contrast. LGE is late gadolinium enhancement. done after 10-25min of the contrast administration. • Dark blood Imaging- on spin echo or steady-state free precession sequences -These can be T1, T2, or proton density weighted sequences - T1 weighted sequences achieve better anatomic definition and T2 and PD weighted sequences reach better tissue characterization MYOCARDIAL INFARCTION IMAGING CASES:
  • 11. 73/F Cine stress MRI shows perfusion defect along anterolateral myocardial wall predominantly in subendocardial region. On cartherization 70% stenosis was noted then PCI was done. Importance of stress MRI which find out the perfusion defect region suggesting chronic stable CAD. microvascular obstruction (MVO) – lack of tissue perfusions (its seen inearly post contrast) as contrast not diffused.
  • 12. rest can be normal, here on stress MRI showing persisent myodcardial perfusion defect. it was post CABG case in 70m post x increasing chest pain non relieved on medicines. surgical intervention was planned.
  • 13. T2 SA HLA bright – edema (excess water content or in short myocardium at risk). T with STIR is commonly done to find out the edema LGE corresponds to edema suggests irreversible damage to the tissue. (non salvagable) Lcx branch.
  • 14. T2 edema-bright LGE infarction with pericardial inflammation.
  • 15. LGE is not reliable indicator of necrosis in acute setting.
  • 16. T2 shows bright-edema with central dark core. first pass contrast shows main microvascular obstruction (MVO) – lack of tissue perfusions (its seen inearly post contrast) as contrast not diffused. on early and late contrast the darker area appear reduced suggesting the diffusion of GD into the necrotic part. on cine (end diastolic and end systolic) shows inferolateral wall shows impaired contraction. additional now T2 dark could reflect the hemorrhage. Cine even shows bright signal pericardium s/o effusion/ inflammation. the blood in T2 will be heterogenous ie peripheral hyperintense rim
  • 17. MYOCARDIAL VIABILITY IMAGING Post contrast enhancement with occlusion. CINE end systolic early and late (6month) shows mardked thinning of the myocardium. following such remodelling revascularition can help. but revascularition would only help in viable, stunned and hybernated myocardium and not necrotic/scarred myocardium. here comes role of CMR to find out the viable myocardium
  • 18. Viability imaging in 57-year- old patient presenting ischaemic cardiomyopathy and increasing dyspnoea CINE showing increased volume, reduced EF, severe thinning. LGE shows transmural enhancment suggesting healed myocardial infarction (non viable) thinning of <6mm even has low chances of reversibility (done in end diaslolic) transmural enhancement in the inferolateral wall reflecting a healed extensive inferolateral myocardial infarction - irreversible damage
  • 19. CINE image shows posterior myocardial wall shows thinning with reduced EF and increased chamber volume. On LGE shows transmural enhancement suggesting MI. on confirmation by angiography shows RCA occlusion.
  • 20. POST MI COMPLICATIONS - Ventricular thrombus common complication associated with ischemic dilated cardimyopathy. common after anterior wall MI. - actually contrast study for CMR is bonus thing as we do it for the detection of MI so can incidentally find i - to differentiate between the myocardial occlusion and intraluminal - for intramyocardial there will be no reflow on late contrast images. - CMR also shows incidentally the presence of pericardial inflammation (this are common association with transmural type of infarction) as we seen in earlier cases could be pericardiatis or pericardial effusion. - aneurysms
  • 21. first pass post contrast (inversioin images) shows transmuaral non enhancement. but on LGE shows endocardial non late enhancement with altered signal and looking at VLA view shows altered signal suggesting presence of mural thrombus in presence of MI
  • 22. CINE - myocardial hypo and thinnin. on early and late contrast shows transmural enhancement and hypointense thrombus with apex aneurysm
  • 23. CMR at 1 wk and after 4months – shows edema them thinning. Subendocardial no reflow and transmural enhancment. Papillary muscles shows no reflow.
  • 24. DIFFERENTIAL SIMILAR TO MI on imaging T2 edema. post contrast in all view shows epicardial and subepicardial enhancement suggesting acute pericarditis. this was case of 17 F with retrosternal pain on BX pericardium lyphohistiocytic infiltrates were noted.
  • 25. T2 WI shows edema in left lateral wall. On LGE enhancement noted mainly in subepicardial region. Its acute myocarditis in 18yr female. CINE and T1 shows hyperintense mass. on LGE shows non enhancing mass with myocardial wall enhancement hyper on T1 and hypo LGE suggests myocaradial hematoma with scarring of the adjacent myocardium - case of post traum to chest in 71m