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Background Diagnosis of chylous effusions normally requires invasive paracentesis. Purpose To assess whether MRI with multipoint Dixon fat quantification allows for noninvasive differentiation of chylous and nonchylous ascites and pleural effusions. Materials and Methods Phantom, ex vivo, and in vivo MRI examinations were performed by using a commercially available multipoint Dixon pulse sequence with a 1.5-T MRI system. Fat fraction values were measured with a region of interest-based approach on reconstructed maps. For phantom evaluation, eight titrated fatty fluid solutions (nonhuman samples) with varying triglyceride content (145-19 000 mg/dL [1.64-214.7 mmol/L]) were examined. For ex vivo evaluation, 15 chylous and five nonchylous study participant fluid samples were examined. In a prospective study performed from June 2016 to February 2018, 29 study participants with known chylous ( n = 17) and nonchylous ( n = 12) effusions were evaluated with MRI. All clinical samples underwent laboratory testing for triglyceride level, total protein level, white blood cells, and red blood cells. Laboratory values were correlated with fat fraction values; the optimal fat fraction threshold was determined to differentiate chylous and nonchylous fluids. Results Phantom analysis showed that fat fraction values correlated with triglyceride content ( r = 0.99, P < .001). In ex vivo studies, multipoint Dixon-derived fat fraction was higher in chylous versus nonchylous fluids (mean, 2.5% ± 1.2 [standard deviation] vs 0.8% ± 0.2; P = .001). Fat fraction was correlated with triglyceride content ( r = 0.96, P < .001). For in vivo studies, fat fraction was greater for chylous versus nonchylous fluids (mean, 6.2% ± 4.3 vs 0.6% ± 0.6; P < .001). In vivo fat fraction was correlated with triglyceride content ( r = 0.96, P < .001). Use of a fat fraction cutoff value greater than 1.8% yielded a sensitivity of 14 of 17 (82% [95% confidence interval (CI): 57%, 97%]) and a specificity of 12 of 12 (100% [95% CI: 74%, 100%]) for differentiation of chylous and nonchylous effusions. Conclusion MRI can help identify chylous versus nonchylous ascites and pleural effusions through use of multipoint Dixon fat quantification. © RSNA, 2020 Online supplemental material is available for this article.

Purpose: The aim of this study was to investigate the diagnostic value of cardiac magnetic resonance (CMR)-derived strain parameters in patients with sarcoidosis, and to compare results to standard CMR markers of sarcoidosis (edema/T2 ratio, early gadolinium enhancement, late gadolinium enhancement) for prediction of disease outcome., Materials and Methods: 61 patients with biopsy-proven sarcoidosis underwent CMR examination. According to CMR results, patients were divided into two different groups: patients with (CMR+; n = 23) and without (CMR-; n = 38) findings consistent with cardiac sarcoidosis. In addition, a group of healthy age-matched volunteers (controls; n = 22) served as controls. Left ventricular functional parameters as well as left ventricular longitudinal and circumferential strain were evaluated in all three groups., Results: Compared to controls, global longitudinal strain (GLS) was significantly impaired in patients with sarcoidosis, irrespective of cardiac involvement. No significant differences in GLS could be revealed between CMR+ and CMR- patients. Circumferential strain parameters were significantly impaired in CMR+ patients in comparison to CMR- patients and controls, while no significant differences could be revealed between CMR- patients and controls. GLS was significantly lower in patients with a negative outcome compared to controls. Compared to the rest of the CMR+ and CMR- patients, the GLS in patients with a negative outcome was further reduced but did not reach statistical significance., Conclusion: GLS is the only strain parameter detecting left ventricular functional impairment in sarcoidosis patients with otherwise unsuspicious CMR and controls. GLS is further reduced in patients with a negative outcome. Thus, GLS may have the potential to serve as a marker for early cardiac involvement in sarcoidosis., Key Points: · GLS is significantly impaired in sarcoidosis patients with an otherwise inconspicuous CMR, compared to controls. · GLS is reduced in patients with a negative outcome. · GLS may serve as a marker for early cardiac involvement in sarcoidosis., Citation Format: · Dabir D, Meyer D, Kuetting D et al. Diagnostic Value of Cardiac Magnetic Resonance Strain Analysis for Detection of Cardiac Sarcoidosis. Fortschr Röntgenstr 2018; 190: 712 - 721., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To investigate the degree of impairment in left (LV) and right ventricular (RV) myocardial strain parameters over the course of acute myocarditis and to evaluate its value for the prediction of functional recovery upon follow-up., Materials and Methods: 69 patients with acute myocarditis underwent cardiac magnetic resonance imaging during the acute stage (baseline) and after a mean 92.5 ± 50.4 days follow-up. Standard "Lake Louise" criteria (T2 signal intensity ratio, early gadolinium enhancement ratio and late gadolinium enhancement) and feature tracking derived LV and RV strain parameters were assessed. Logistic regression analysis was used to find predictors of functional recovery upon follow-up., Results: All inflammatory parameters showed a considerable decrease over the course of the disease (P < 0.001 for all parameters). LV and RV function significantly improved on follow-up CMR (LV ejection fraction: 53.5 ± 12.7 % vs. 61.3 ± 9.5 %; P < 0.001, RV ejection fraction: 54.1 ± 10.0 % vs. 59.4 ± 6.3 %; P < 0.001). LV and RV myocardial strain (longitudinal, circumferential and radial strain) significantly improved from baseline to follow-up (P < 0.05 for all parameters). On multivariate analysis, LV global peak systolic longitudinal strain (OR: 0.303; P = 0.007) was the only independent predictor of functional recovery upon follow-up.  CONCLUSION:  Alterations in LV and RV functional strain parameters occur frequently during the acute stage of myocarditis. During the course of the disease, a significant improvement in LV and RV strain parameters can be observed. It further appears that initial LV longitudinal strain may serve as a new parameter for the prediction of functional recovery upon follow-up., Key Points: · Myocardial strain parameters significantly improve during the course of acute myocarditis.. · RV dysfunction can frequently be observed during the acute stage of myocarditis.. · LV longitudinal strain can independently predict functional recovery upon follow-up.., Citation Format: · Luetkens JA, Petry P, Kuetting D et al. Left and right ventricular strain in the course of acute myocarditis: a cardiovascular magnetic resonance study. Fortschr Röntgenstr 2018; 190: 722 - 732., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: Complex post-processing is required for strain-derived assessment of diastolic dysfunction (DD) using CMR-tagging (TAG). Feature-tracking (FT), allows for rapid systolic strain assessment using conventional steady-state free precession (SSFP)-Cine sequences. Aim of this study was to investigate whether FT may be employed for the clinically applicable quantification of DD., Methods and Results: 40 individuals (20 patients with DD I-III°, 20 controls) were investigated. CSPAMM and SSFP-Cine sequences were acquired in identical short-axis locations. Global and regional early diastolic strain rate (EDSR), peak diastolic strain rate (PDSR), twist, untwist and torsion were calculated from tagged and SSFP-Cine datasets. DD indices were compared, intra- as well inter-observer variability assessed., Results: for global EDSR correlated strongly (r=0.94), revealed good agreement and no significant differences between both methods. Correlation for regional EDSR was lower, results differed significantly in the anterior wall (p<0.05). Correlation for PDSR was moderate (r=0.63), results in the healthy control group differed significantly (p<0.05). FT derived rotational indices correlated poorly with TAG (twist: r=0.28; untwist: r=0.02; torsion: r=0.26), subgroup analysis revealed significant differences (p<0.05). Intra- and inter-observer variability for FT derived global EDSR and PDSR were comparable to TAG, but significantly higher for regional EDSR and rotational indices., Conclusion: FT derived global EDSR allows for rapid clinical determination of diastolic dysfunction, revealing good agreement with TAG and low intra- as well as interobserver variability. However, TAG analysis not only yields higher accuracy and reproducibility of global- and regional diastolic strain, but also delivers reliable information about diastolic rotational and untwisting dynamics., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)