CARDIAC MRI GALLERY
F/35 c/o syncope after 10 km marathon
Classical hypertrophic cardiomyopathy (HCM) with asymmetrical left ventricular myocardial thickening. It usually occurs in young patient presenting with dyspnea on exertion, angina and even sudden cardiac death. MRI could assess the diastolic dysfunction, mitral regurgitation, left ventricular outflow tract obstruction, and most important of all, documentation of late gadolinium enhancement (LGE) which indicates myocardiac scar. This patient opts for implantable cardioverter defibrillator.
M/70 Chronic hypertension
Cardiac Amyloidosis, hypertensive cardiomyopathy, and hypertrophic cardiomyopathy (HCM) could lead to concentric myocardial thickening. Measuring the native T1 value of the myocardium and the extra-cellular volume (ECV) could help the differentiation, paving the way for treatment stratification and future potential novel remedy.
M/52 Assess myocardial viability for intervention
Adenosine Stress CMR is a safe investigation for obstructive coronary artery disease, producing high diagnostic accuracy as good as radioactive pharmauetical stress test. Image at left side shows subendocardial perfusion defect at maximal stress, whilst the right one shows chronic transmural infarct with microvascular obstruction, ie non-viable myocardium.
F/45 Arrhythmia and abnormal CXR
Cardiac sarcoidosis is uncommon. Correct diagnosis by MRI and localization of the late gadolinium enhancement provide crucial information for management, especially if cardiac transplant is an option. The image at right shows the mediastinal lymphadenopathy of sarcoidosis.
Contrast-enhanced MR Angiogram
Gadolinium-based contrast enhanced MR angiogram technique is widely used to assess carotico-vertebral system, renal artery, lower limb run-off for peripheral vascular disease, and left atrium and pulmonary vein for pre-ablation anatomical mapping. In recent years, there has been rising concern of a rare gadolinum-related disease named nephrogenic systemic fibrosis (NSF). To avoid this potential complication, FDA of USA and EMA of European Community recommend that only macrocyclic MRI contrast should be used in these examinations.
Our centre follows the FDA and EMA of EC guidelines.