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OBJECTIVES This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). METHODS From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. RESULTS Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p

Despite standardization efforts, vendors still use specific proprietary software algorithms for echocardiographic strain measurements, which result in high inter-vendor variability. Using vendor-independent software could be one solution. Little is known, however, how vendor specific image characteristics can influence tracking results of such software. We therefore investigated the reproducibility, accuracy, and scar detection ability of strain measurements on images from different vendors by using a vendor-independent software. A vendor-independent software (TomTec Image Arena) was used to analyse datasets of 63 patients which were obtained on machines from four different ultrasound machine vendors (GE, Philips, Siemens, Toshiba). We measured the tracking feasibility, inter-vendor bias, the relative test-re-test variability and scar discrimination ability of strain measurements. Cardiac magnetic resonance delayed enhancement images were used as the reference standard of scar definition. Tracking feasibility on vendor datasets were significantly different (p < 0.001). Variability of global longitudinal strain (GLS) measurements was similar among the vendors whereas variability of segmental longitudinal strain (SLS) showed modest difference. Relative test-re-test variability of GLS and SLS showed no relevant differences. No significant difference in scar detection capability was observed. Average GLS and SLS values were similar among vendors. Reproducibility of GLS measurements showed no difference among vendors and was in acceptable range. SLS reproducibility was high but similar for all vendors. No relevant difference was found for identifying regional dysfunction. Tracking feasibility showed a substantial difference among images from different vendors. Our findings demonstrate that tracking results depend mainly on the software used and show little influence from vendor specific image characteristics.

Cardiovascular magnetic resonance imaging (CMR) has been established as a modality to detect myocardial viability. The aim of this study was to evaluate myocardial viability by observing transmural extent of infraction and microvascular perfusion level.We performed CMR in 30 myocardial infarction (MI) patients within 7-10 days. At the 6‑month follow-up, CMR was used to evaluate the impact of abnormal reperfusion and observe the transmural extent of infraction on recovery of function.The left ventricle was divided into 16 segments using the American Heart Association classification. Infarcts were detected in 202 of the 480 segments (42%) by delayed enhancement magnetic resonance imaging (DE-MRI). According to first-pass myocardial perfusion, abnormal perfusion was detected in 278 of 480 segments (60%), reduced perfusion was identified in 173 of 278 (62%), and perfusion defects in 105 of 278 segments (38%). The results showed that the segments with abnormal perfusion were larger than in DE-MRI (P 0.05), indicating that the area of abnormal perfusion segments extend significantly beyond the region of infarction. Microvascular perfusion with an infarcted region was lower compared to non-infarcted segments (P 0.05). The extent of myocardial hyperenhancement correlated inversely with microvascular perfusion (P 0.05). Segments with severe microvascular perfusion and75% transmural infarction on the 7‑ to 10-day scan had markedly increased at the 6‑month follow-up (P 0.01), indicating a lack of recovery of cardiac function.DE-MRI combined with microvascular perfusion may be effective to detect viable myocardium in patients with MI and may provide a means of predicting whether revascularization will be effective.

The aim of our study is to describe the multiphasic CT features of fibrolamellar hepatocellular carcinomas (FLHCCs) and pattern of distant metastases. 33 patients (mean age 28 years: 17M/16F) with pathologically confirmed FLHCC and pre-treatment multiphasic CT were included in the study. Two abdominal radiologists evaluated the multiphasic CT imaging features of these 33 FLHCC patients in consensus. Solitary hepatic mass was seen in 67% (22/33). Mean tumor size was 11.3 cm (range 4.6–22 cm). Tumor was well-defined in 64% (21/33). In the pre-contrast CT, 91% (30/33) were hypoattenuating. Central stellate scar was present in 73% (24/33). In FLHCC having central stellate scar, calcification within the central scar was seen in 88% (21/24). In the hepatic arterial phase, 82% (27/33) were hyperattenuating relative to liver. In the portal venous phase, 36% (12/33) were hyperattenuating, 46% (15/33) were isoattenuating, and 18% (6/33) were hypoattenuating. In the delayed phase images, 24% (8/23) were hyperattenuating, 67% (22/33) were isoattenuating, and 9% (3/33) were hypoattenuating. Delayed enhancement of the central stellate scar was seen in 12% (4/33). Distant metastases were seen in 54% (18/33). The most common site of metastases was lungs and was seen in 89% (16/18) of the patients with metastatic disease. FLHCC typically manifests as a large, solitary mass demonstrating heterogeneous hypervascular enhancement in the arterial phase. Most tend to be isoattenuating in delayed phase. Central stellate scar with internal calcification is a useful imaging feature that can help in the diagnosis of FLHCC. Lungs are the most common site of distant metastases in FLHCC.

To evaluate the feasibility of cardiac CT for the evaluation of myocardial delayed enhancement (MDE) in the assessment of patients with cardiomyopathy, compared to cardiac MRI. A total of 37 patients (mean age 54.9 ± 15.7 years, 24 men) who underwent cardiac MRI to evaluate cardiomyopathy were enrolled. Dual-energy ECG-gated cardiac CT was acquired 12 min after contrast injection. Two observers evaluated cardiac MRI and cardiac CT at different kV settings (100, 120 and 140 kV) independently for MDE pattern-classification (patchy, transmural, subendocardial, epicardial and mesocardial), differentiation between ischemic and non-ischemic cardiomyopathy and MDE quantification (percentage MDE). Kappa statics and the intraclass correlation coefficient were used for statistical analysis. Among different kV settings, 100-kV CT showed excellent agreements compared to cardiac MRI for MDE detection (κ = 0.886 and 0.873, respectively), MDE pattern-classification (κ = 0.888 and 0.881, respectively) and differentiation between ischemic and non-ischemic cardiomyopathy (κ = 1.000 and 0.893, respectively) for both Observer 1 and Observer 2. The Bland-Altman plot between MRI and 100-kV CT for the percentage MDE showed a very small bias (-0.15%) with 95% limits of agreement of -7.02 and 6.72. Cardiac CT using 100 kV might be an alternative method to cardiac MRI in the assessment of cardiomyopathy, particularly in patients with contraindications to cardiac MRI.

In an elderly population, the prevalence of unrecognized myocardial infarction (UMI) scars found via late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging was more frequent than expected. This study investigated whether UMI scars detected with LGE-CMR at age 70 would be detectable at age 75 and whether the scar size changed over time. From 248 participants that underwent LGE-CMR at age 70, 185 subjects underwent a follow-up scan at age 75. A myocardial infarction (MI) scar was defined as late enhancement involving the subendocardium. In the 185 subjects that underwent follow-up, 42 subjects had a UMI scar at age 70 and 61 subjects had a UMI scar at age 75. Thirty-seven (88 %) of the 42 UMI scars seen at age 70 were seen in the same myocardial segment at age 75. The size of UMI scars did not differ between age 70 and 75. The prevalence of UMI scars detected at LGE-CMR increases with age. During a 5-year follow-up, 88 % (37/42) of the UMI scars were visible in the same myocardial segment, reassuring that UMI scars are a consistent finding. The size of UMI scars detected during LGE-CMR did not change over time. • UMI scars detected by LGE-CMR are frequent in elderly. • The prevalence of UMI scars detected with LGE-CMR increases with age. • UMI scar size does not change over time.

Background Cardiac MR is helpful in the diagnosis and prognosis of endomyocardial fibrosis[EMF]. Among the two types of endomyocardial fibrosis, tropical endomyocardial fibrosis is geographically restricted to tropical parts of Africa, Latin America and in the southern districts of India, especially along the coastal region of Kerala. Various toxic and environmental factors were postulated as the etiopathogenesis of tropical endomyocardial fibrosis. Endomyocardial fibrotic wall thickening of apex and subvalvular regions of one or both ventricles results in restrictive pattern. Typical delayed enhancement pattern is the subendocardial enhancement which is prominent in the apex and extending up to the subvalvular regions

Background A fundamental component of the CMR exam is contrast enhanced imaging, which is crucial for delineating diseased from normal tissue. Unfortunately, diseased tissue adjacent to vasculature often remains hidden since there is poor contrast between hyperenhanced tissue and bright blood-pool. Conventional black-blood double-IR methods are not a solution; these were not designed to function after contrast administration since they rely on the long native T1 of blood (~2s at 3T) and adequate blood flow within this time period. We introduce a novel Flow-Independent Dark-blood DeLayed Enhancement technique (FIDDLE) that allows visualization of tissue contrast-enhancement while suppressing blood-pool signal. We validate FIDDLE in an animal model of myocardial infarction (MI) and demonstrate feasibility in patients.

Histopathologic findings in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) are replacement of the normal myocardium with fatty and fibrous elements with preferential involvement of the right ventricle. The right ventricular fibrosis can be visualised by post-gadolinium delayed enhancement inversion recovery imaging (DE imaging). We compared the image quality of three different gradient echo MRI sequences for short axis DE imaging of the right ventricle (RV). We retrospectively analysed MRI scans performed between February 2005 and December 2008 in 97 patients (mean age: 41.2 years, 67% men) suspected of ARVC/D. For DE imaging either a 2D Phase Sensitive (PSIR), a 2D (2D) or a 3D (3D) inversion recovery sequence was used in respectively 38, 32 and 27 MRI-examinations. The RV, divided in 10 segments, was assessed for image quality by two radiologists in random sequence. A consensus reading was performed if results differed between the two readings. Image quality was good in 24% of all segments in the 3D group, 66% in the 2D group and 79% in the PSIR group. Poor image quality was observed in 51% (3D), 10% (2D), and 2% (PSIR) of all segments. Exams were considered suitable for clinical use in 7% of exams in the 3D group, 75% of exams in the 2D group and 90% of exams of the PSIR group. Breathing-artifacts occurred in 22% (3D), 59% (2D) and 53% (PSIR). Motion-artifacts occurred in 56% (3D), 28% (2D) and 29% (PSIR). Post-gadolinium imaging using the PSIR sequence results in better and more consistent image quality of the RV compared to the 2D and 3D sequences.

To assess the signal pattern in T2-weighted images (T2WI) and determine its relation to persistent microvascular obstruction (PMO) and intramyocardial hemorrhage in a porcine model with reperfused acute myocardial infarction. Left anterior descending artery was occluded (90 or 180 min) and reperfused (90 min). T2WI and delayed-enhanced magnetic resonance images (DE-MRI) were acquired. The T2WI signal pattern, T2WI contrast ratio, PMO, and intramyocardial hemorrhage were evaluated, and their interrelationships were analyzed. The infarct area on T2WI was recorded as a homogeneous high-intensity signal or as low- or iso-intensity signals. The contrast ratio of the T2WI in the cases with PMO was significantly lower than that in those without PMO (1.38 ± 0.25 vs. 1.89 ± 0.31, P < 0.05), and it showed significant inverse correlation with the extent of PMO observed in DE-MRI images (r =−0.8, P < 0.05). The extent of PMO correlated strongly with that of intramyocardial hemorrhage (r = 0.97, P < 0.05). The abnormal signal area in the T2WI was larger than the infarct area in the DE-MRI images (47.0 ± 9.9% vs. 37.8 ± 9.9%, P < 0.05) and the infarct area observed after TTC staining (47.0 ± 9.9% vs. 37.4 ± 8.4%, P < 0.05). We observed variable T2WI signal patterns for the infarcted myocardium. Lower T2WI contrast ratios significantly correlated with the extent of PMO in DE-MRI and intramyocardial hemorrhage in the gross specimen.

We report two cases of inflammatory myofibroblastic tumor (IMT) of the lung in a 4-year-old boy and a 7-year-old girl. We performed dynamic contrastenhancement computed tomography in both of our cases and dynamic contrast enhancement magnetic resonance imaging (MRI) in one case. These dynamic studies showed a demarcated mass with delayed enhancement in both cases. A T1-weighted MR image shows a mass with homogeneous low signal intensity, and a T2- weighted image shows a mass with slightly high signal intensity. A post-contrast-enhanced T1-weighted image demonstrates homogeneous enhancement. We speculate that the delayed enhancement could be attributed to the abundant fibrous tissue, which was the main structural material of the tumor. This same finding has been described in previous reports of IMT in other organs.

The purpose of this study was to evaluate delayed enhancement (DE) of the aortic wall of atherosclerotic aneurysms using computed tomography and to evaluate the relationships between DE and wall thickness of abdominal aortic aneurysm (AAA), diameter of AAA, serum levels of C-reactive protein (CRP) which indicate inflammation status, and pathological findings. Computed tomographic images of atherosclerotic AAA in 110 patients were studied between July 2001 and March 2003. Computed tomography (CT) scanning included unenhanced, enhanced early, and enhanced delayed phases. Pathological findings were obtained from 19 of the 110 patients. We determined DE of the AAA wall and assessed the association between DE and AAA wall thickness, AAA diameter, serum levels of CRP, and pathological findings. Delayed enhancement on CT was demonstrated in 66 of 110 patients with atherosclerotic AAA (60.0%). Patients with DE demonstrated significantly larger AAA diameter (4.8 +/- 0.9 versus 3.9 +/- 0.6 cm, P0.0001) and significantly higher levels of CRP (5.0 +/- 6.0 versus 2.3 +/- 2.9 mg/l, P = 0.033) than those patients without DE. Patients with DE also had significantly thicker and more severe atheroma and a tendency toward more prominent inflammation and vascularity in pathologic findings. There was no significant difference in wall thickness between AAA with and without DE (1.44 +/- 0.7 versus 1.24 +/- 0.22 mm, P = 0.352). Delayed enhancement on CT demonstrated in over half of atherosclerotic AAA may be associated with chronic inflammation by atherosclerosis.

Results A total of 1,581 patients (38% females) were included. In first few years of the initiation of the service, most patients were referred for assessment of viability (54%) followed by assessment of etiology of cardiomyopathy (19%). However, in the subsequent years, viability referrals decreased and there was a steady increase in other indications (assessment of LV function, arrhythmias, cardiac masses, congenital heart disease,..etc.) (figure). Referral to stress MRI continued to be very low (less than 1%). 46% of the reoffered patients had an ejection fraction less than 50% and 42% of the patients had evidence of myocardial delayed enhancement.

Methods The population comprised consecutive patients with central venous catheters undergoing CMR at Memorial Sloan Kettering Cancer Center (NY, NY). Delayed enhancement CMR (inversion recovery GRE) was used to identify RT; defined as a right atrial (RA) mass with avascular tissue characteristics (non-enhancing) on “long TI” (600msec) DE-CMR. Cine-CMR (SSFP) was used to quantify cardiac structure and function, including RA and RV function and chamber size. Clinical indices were categorized based on medical record review. Echo (if performed within 14 days of CMR) was retrieved from image archives and independently read for RT. Clinical records were queried for documented pulmonary embolus (PE) within 60 days of CMR.

Purpose: To evaluate six algorithms for segmenting non-viable left ventricular (LV) myocardium in delayed enhancement (DE) magnetic resonance imaging (MRI). Methods: Twenty-three patients with known chronic ischemic heart disease underwent DE-MRI. DE images were first manually thresholded using an interactive region-filling tool to isolate non-viable myocardium. Then, six thresholding algorithms, based on the image intensity characteristics of either LV blood pool (BP), viable LV myocardium, or both, were applied to each image. For the Mean−2SDBP algorithm, thresholds were equal to the mean BP intensity minus twice its standard deviation. For the Mean+2SDSemi, Mean+3SDSemi, Mean+2SDAuto, and Mean+3SDAuto algorithms, thresholds equaled the mean intensity of viable myocardium plus twice (or thrice, as denoted by the name) the standard deviation of intensity (subscripts denote how these values were determined: automatic or semi-automatic). For the Minimum Intensity algorithm, the threshold equaled the minimum intensity between the BP and LV myocardium mean intensities. Percent Scar was defined as the ratio of non-viable to total myocardial pixels in each image. Agreement between each algorithm and manual thresholding was assessed using Bland–Altman analysis. Results: Mean Percent Scar was 25 ± 16% by manual thresholding. Five of the six algorithms demonstrated mean bias within ±3% (all except Mean+2SDAuto); however, limits of agreement (LoA) were large in general (range 12–36%). The best overall agreement was demonstrated by the Mean+2SDSemi (bias, 0%; LoA, 12%) and Mean+3SDSemi(bias, −3%; LoA, 14%) algorithms. Conclusion: On average, five of the six algorithms proved satisfactory for clinical implementation; however, in some images, manual correction of automatic results was necessary.

Myocardial viability is of established importance to the management of cardiac patients being considered for revascularization. Existing noninvasive imaging tests to examine myocardial viability, such as stress echocardiography and nuclear scintigraphy, are of recognized utility but are subject to intrinsic limitations. Over the past few years delayed-enhancement MRI (DE-MRI) has emerged as an alternative to traditional tests and for the first time allows direct visualization of the transmural extent of myocardial viability. In this paper we review the scientific data that underlie the use of DE-MRI in patients with ischemic heart disease. Progress in this area is largely the result of the development of a new MRI pulse sequence in the late 1990s, which improved the detection of necrotic and scarred myocardial tissue. Following this technical development, a series of detailed histologic comparisons in large animal models revealed that both acute and healed myocardial infarcts appeared as brighter (hyperenhanced) areas than viable regions, and that the effect is independent of contractile function. The resulting 'bright is dead' hypothesis has thus far proven of significant use in patients with ischemic heart disease. Data are now emerging which suggest that the DE-MRI technique also has important implications for patients with nonischemic forms of cardiomyopathy.

Background High-resolution late gadolinium enhancement (LGE) MRI is used to assess fibrosis of the left atrium (LA) and visualize post-ablation scar in patients with atrial fibrillation (AF). Only few centers with advanced expertise in cardiac MR (CMR) have shown successful and good quality LGE-MRI of the LA. In this work, we assess the dependence of image quality of LGE images on the number of patients imaged in the centers participating in the multi-center trial DECAAF (Delayed Enhancement - MRI determinant of successful Catheter Ablation of Atrial Fibrillation). Also, main causes of poor image quality were determined. Methods Fifteen centers with different degrees of CMR expertise and typical MRI hardware participated in DECAAF.

We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement.

Rationale and objectives: To determine the relationship between the lesion and the scar enhancement characteristics in a series of hepatic Focal Nodular Hyperplasia (FNH) lesions studied with dynamic MR imaging.Methods: Nine patients with FNH were studied. The slice showing the largest scar was selected for the dynamic single slice T1-weighted Gradient-echo sequence before and after contrast administration (15 images, one every 20 s). Analysis was performed with ROI measurements in the lesion and the scar. Signal-intensity and enhancement curves were obtained from both structures.Results: Dynamic MRI showed the typical homogeneous early enhancement of the lesion with delayed enhancement of the scar. The scar enhanced early and vigorously in all cases. Two patterns of enhancement curves were defined. In the parallel pattern, both curves started early, quickly reaching a plateau maintained over time (77.8%). In the divergent pattern the curve of the scar was above the curve of the FNH (22.2%). after the maximum slope was reached, with progressive separation of the curves.Conclusion: There is a hypervascular scar enhancement within FNH lesions with either a parallel or divergent course after the maximum early enhancement.

The role of anxiety in thought control wasinvestigated following exposure to distressing orneutral stimuli. High- and low-anxious participants (N=96) were administered suppression or nonsuppressioninstructions following the viewing of either a neutral ordistressing film. Performance on a secondary word taskindexed demands on attentional capacity made by thoughtsuppression and anxiety. There was a delayed enhancement of film-related thoughts which was mediated byanxiety. Findings are discussed in terms of ironiccontrol theory and the implications for clinicalphenomena.

A 42-year-old male with acute chest pain referred for acute myocarditis versus myocardial infarction (MI) was examined with magnetic resonance imaging (MRI). Clinical presentation and MRI findings are reviewed.

We report a case of delayed enhancement of myocardial FDG uptake in NIDDM patient after oral glucose loading. A 65-year-old man who had a past history of NIDDM received FDG-PET examination during fasting and glucose loading. In neither condition, was an accumulation of FDG in the myocardium, and myocardial blood flow was normal. An oral glucose tolerance test (OGTT) was performed to find the best time for FDG injection and 3 hours after loading, the serum insulin concentration was increased significantly. When the interval between glucose loading and the injection of FDG was set at 3 hours, enhancement of myocardial FDG uptake was demonstrated. To know the best time for the FDG injection in advance is thought to be important in obtaining better image quality and interpreting the myocardial viability when FDG-PET examination during glucose loading is performed in NIDDM patients.

Background Myocardial delayed enhancement (MDE) by gadolinium-enhanced cardiac MRI is well established for myocardial scar assessment in ischemic and non-ischemic heart disease. The role of MDE by cardiac CT (CT-MDE) is not yet defined. Findings We reviewed all clinical cases of CT-MDE at a tertiary referral center to present the cases as a case series. All clinical cardiac CT exams which utilized CT-MDE imaging between January 1, 2005 and October 1, 2010 were collected as a series and their findings were also compared with available myocardial imaging to assess for myocardial abnormalities, including echocardiography (wall motion, morphology), cardiac MRI (delayed enhancement, morphology), SPECT MPI (perfusion defects). 5,860 clinical cardiac CT exams were performed during the study period. CT-MDE was obtained in 18 patients and was reported to be present in 9 patients. The indications for CT-MDE included ischemic and non-ischemic heart diseases. In segments positive for CT-MDE, there was excellent agreement of CT with other modalities: echocardiography (n=8) demonstrated abnormal morphology and wall motion (k=1.0 and k=0.82 respectively); prior MRI (n=2) demonstrated abnormal delayed enhancement (MR-MDE) (k=1.0); SPECT MPI (n=1) demonstrated fixed perfusion defects (k=1.0). In the subset of patients without CT-MDE, no abnormal segments were identified by echocardiography (n=8), MRI (n=1) and nuclear MPI (n=0). Conclusions CT-MDE was performed in rare clinical situations. The indications included both ischemic and non-ischemic heart disease and there was an excellent agreement between CT-MDE and abnormal myocardium by echocardiography, cardiac MRI, and nuclear MPI.

Background Atrial fibrillation (AF) is the commonest sustained arrhythmia afflicting the adult population. Identifying and ablating triggers in the left atrium (LA) or more often the pulmonary veins (PV) with radiofrequency energy to restore sinus rhythm is fast becoming the mainstay of treatment. The success of the procedure often requires a combination of imaging techniques with an electroanatomical mapping system. We describe the use of three dimensional (3D) delayed enhancement cardiovascular magnetic resonance imaging (DE-MRI) to provide a road map of the anatomy as well as regions of scar tissues in the LA and PV for AF ablation. Methods

Methods Fifty-four patients with CD were analyzed, 16 patients in the indeterminate form (IND), 17 patients with the cardiac form without systolic dysfunction (CF), and 21 patients with the cardiac form with systolic dysfunction (CFSD). All patients underwent 1.5-T cardiac magnetic resonance (CMR) using three pulse sequences, previously described as useful for the diagnosis of viral myocarditis: the myocardial delayed enhancement (MDE) technique, Triple-IR FSE T2-weighted sequence and the T1 weighted global enhancement acquired before and after contrast injection, to identify fibrosis, edema and hyperemia of the myocardium, respectively. The parameters for all sequences followed precisely the recommendations for acute myocarditis published on JACC White Paper (Friedrich et al. J Am Coll Cardiol. 2009 Apr 28;53(17):1475-87).

Summary Lateral wall infarction on DE-CMR, independent of papillary muscle involvement, confers increased risk for ischemic mitral regurgitation. Background The mitral apparatus contains two myocardial components - papillary muscles and the adjacent left ventricular (LV) wall. Delayed enhancement CMR (DE-CMR) enables in-vivo study of potential contributions of LV wall and papillary muscle infarction (PMI) to MR. This study examined the relative impact of papillary muscle and LV wall infarction on mitral regurgitation (MR) following ST elevation MI (STEMI). Methods Multimodality imaging was prospectively performed among patients with first STEMI: DE-CMR (IR-GRE, acquired 10-30 minutes post gadolinium [0.2 mmol/kg]) was used to assess LV infarct pattern - including PMI (graded by location and extent - complete or partial, stratified using threshold of >50% papillary myocardium) and LV wall infarction (17 segment model, 5 point score/segment). Cine-CMR (SSFP) was analyzed for cardiac function and geometry - including LV chamber size, regional wall motion (5 point score/segment), and mitral annular diameter. Echocardiography (echo) was used to quantify MR (0-4+ grade) using established consensus criteria. Each imaging modality was read independently.

Methods 15 patients with paroxysmal atrial fibrillation (PAF) underwent CMR scanning pre and immediately post WACA. 12 patients (4 male; mean age 56±11 years) had good quality images for delayed enhancement DE (necrosis) [Figure 1a,1b] and high T2-weighted signal (oedema) [Figure 1c,1d]. Images were analysed to quantify the circumferential extent of lesion formation with both imaging sequences. Clinical follow-up results at 6 months were then correlated with the MR findings.

Background The presence of microvascular obstruction (MO) on delayed enhanced cardiac magnetic resonance (DECMR) imaging is associated with adverse remodeling and poor prognosis after STEMI. Identifying which patients that may develop MO prior to undergoing acute mechanical reperfusion maybe important in managing patients for more direct interventions. We sought to evaluate clinical predictors of MO as depicted by DECMR. Methods We included 255 patients with their first STEMI reperfused with primary percutaneous intervention. A standard DE-CMR was performed acutely at a mean of 3.9±2.0 days after admission. Clinical risk factors, time to reperfusion as well as angiographic variables were prospectively collected. The angiographic area at risk and the infarct size as a % of the left ventricle (LV) were computed. The number of segments with MO, defined as an area of hypoenhancement surrounded by delayed enhancement on DE-CMR, were summed to calculate MO extent.

Viability assessment by delayed-enhanced (DE) MR in patients with coronary artery disease (CAD) can predict improvement of ejection fraction (EF) after revascularization. However it is implication on survival is incompletely understood. Several studies suggested that large amounts of of DE, ie non-viable myocardium, increase risk of death. However these studies did not take into account the presence of CAD and and the potential protective effect of revascularization therapy on outcome. Also they conflict with earlier work employing nuclear imaging or Dobutamine Echocardiography who reported that large amounts of viable myocardium predict worse outcome if such myocardium is not revascularized.

Results 1) RA: Stress PDs were seen in two out of 18 RA patients (11%), one of whom had circumferential subendocardial PD and one had a non-segmental subendocardial PD. Seven patients were found to have DE (39%). DE was observed in six without PD and one patient with PD demonstrated DE. Five had a DE in the middle or subepicardial layer. The remaining two had a subendcardial DE in segment.2) SSc: Stress PDs were seen in five out of nine SSc patients (56%), four of whom had non-segmental subendocardial perfusion defects and one had a segmental subendocardial perfusion defect. Three patients were found to have DE (33%). DE was not observed in any patient without perfusion defect and among the five patients with perfusion defects, three (60%) demonstrated delayed enhancement. Two of the three had nonsegmental DE in the middle l layer and one had segmental subendocardial DE.

Introduction Myocardial delayed enhancement (MDE) imaging of infarction is commonly performed using an inversion-recovery (IR) two-dimensional (2D) breath-held fast gradient recalled echo (FGRE) pulse sequence. Three-dimensional (3D) imaging can improve scanning efficiency by acquiring the desired volume in a single breath-hold. Fat suppression could greatly improve visualization of epicardial enhancement (which occurs in transmural myocardial infarction and myocarditis) as well as pericardial enhancement.

Introduction Delayed-enhancement (DE) in the left atrium following radiofrequency (RF) ablation has been previously shown [1]. However, current DE techniques do not reach sufficient resolution to determine if ablation lesions are transmural, a factor that can determine the success of an ablation procedure. Myocardial thickness in the left atrium can reach approximately 1 mm [2]. Therefore a delayed enhancement imaging sequence must be sub-millimetre in resolution. For this requirement, we develop a high resolution inversion recovery (IR) sequence with a spiral k-space trajectory. A spiral trajectory is a very efficient sampling scheme that allows for a very short acquisition window (minimising cardiac blurring) at a much reduced cost to overall imaging time compared to Cartesian.

Methods Velocity encoded MRI was performed in 80 HCM and 35 normal control subjects. PWV was determined between the mid ascending and descending thoracic aorta. Delayed enhancement MRI was acquired for identification of myocardial fibrosis. Quantitative analysis of the scar was performed using advanced software package (Philips, The Netherlands). LV mass was evaluated by drawing endocardial and epicardial contours in cine-SSFP images. Diastolic function and LVOT gradients were evaluated by echocardiography. Diastolic function was graded from 03 and LVOT gradient was significant if > 30 mm Hg.

ss Open Acce Oral presentation Myocardial fibrosis by delayed enhancement cardiovascular magnetic resonance and HCV infection in thalassemia major patients Alessia Pepe1, Antonella Meloni1, Zelia Borsellino2, Maria Chiara Dell'Amico1, Vincenzo Positano1, Caterina Borgna-Pignatti3, Aurelio Maggio4, Gennaro Restaino5, Francesco Gagliardotto2, Paolo Cianciulli6, Luciano Prossomariti7, Aldo Filosa7, Michele Centra8, Domenico D'Ascola9, Antonella Quarta10, Angelo Peluso11, Antonello Pietrangelo12, Eliana Cracolici13, Massimo Lombardi*1 and Marcello Capra2

Introduction Right ventricular (RV) functional and structural monitoring is important as a prognostic measure in pulmonary hypertension (PH) patients. Cardiac magnetic resonance (CMR) imaging is the standard of reference for RV anatomical and functional assessment. Using delayed enhancement (DE)-CMR, presence of myocardial scar in association with PH was typically described at the RV septal insertions. However, its etiology in relation to RV remodeling, altered regional mechanics and pulmonary hemodynamics has not been fully assessed.

In planimetric measurement of left ventricular (LV) mass and volumes, selection of the most basal short-axis cine MR image plane is generally not standardized and may affect calculation of relative infarct size in post-myocardial infarct (MI) patients.

Introduction Delayed enhancement MRI (DE-MRI) has been established as a diagnostic imaging standard for myocardial viability assessment. The current reference standard for DE-MRI uses an inversion-recovery 2D gradient echo sequence to acquire images during repetitive breathholds. This breath-hold 2D (2DBH) technique requires significant patient cooperation and suffers from potential slice misregistration due to diaphragmatic excursions in different breath-holds. To overcome these limitations, navigator-gated 3D (3DNAV) DE-MRI has been developed using a diaphragmatic navigator to monitor respiratory motion and adjust data acquisition accordingly. Previous 3DNAV sequences employed the accept/reject gating algorithm with a fixed gating window which can lead to long imaging time in the case of a steady diaphragmatic drift.