Contrast-enhancement cardiac magnetic resonance imaging beyond the scope of viability

The clinical applications of cardiovascular magnetic resonance imaging with contrast enhancement are expanding. Besides the direct visualisation of viable and non-viable myocardium, this technique is increasingly used in a variety of cardiac disorders to determine the exact aetiology, guide proper treatment, and predict outcome and prognosis. In this review, we discuss the value of cardiovascular magnetic resonance imaging with contrast enhancement in a range of cardiac disorders, in which this technique may provide insights beyond the scope of myocardial viability

Cardiovascular magnetic resonance in pericardial diseases

The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. Not only the clinical presentation may be atypical, mimicking other cardiac, pulmonary or pleural diseases; in developed countries a shift for instance in the epidemiology of constrictive pericarditis has been noted. Accurate decision making is crucial taking into account the significant morbidity and mortality caused by complicated pericardial diseases, and the potential benefit of therapeutic interventions. Imaging herein has an important role, and cardiovascular magnetic resonance (CMR) is definitely one of the most versatile modalities to study the pericardium. It fuses excellent anatomic detail and tissue characterization with accurate evaluation of cardiac function and assessment of the haemodynamic consequences of pericardial constraint on cardiac filling. This review focuses on the current state of knowledge how CMR can be used to study the most common pericardial diseases

Non-invasive imaging in the diagnosis of acute viral myocarditis

Autopsy series of consecutive cases have demonstrated an incidence of myocarditis at approximately 1–10%; on the contrary, myocarditis is seriously underdiagnosed clinically. In a traditional view, the gold standard has been myocardial biopsy. However, it is generally specific but invasive and less sensitive, mostly because of the focal nature of the disease. Thus, non-invasive approaches to detect myocarditis are necessary. The traditional diagnostic tools are electrocardiography, laboratory values, especially troponin T or I, creatine kinase and echocardiography. For a long period, nuclear technique with indium-111 antimyosin antibody has been used as a diagnostic approach. In the last years, the use of this technique has declined because of radiation exposure and 48-h delay in obtaining imaging after injection to prevent blood pool effect. Thus, a non-invasive diagnostic approach without radiation and online image availability has been awaited. Cardiac magnetic resonance imaging has these promising characteristics. With this technique, it is possible to analyse inflammation, oedema and necrosis in addition to functional parameters such as left ventricular function, regional wall motion and dimensions. Thus, cardiovascular magnetic resonance imaging has emerged as the most important imaging tool in the diagnostic procedure and the review focus on this field. But there are also advances in echocardiography and computer tomography, which are described in detail

classification

The aims of this study were to investigate the anatomy of the minor fissure and its variations on high-resolution CT (HRCT) sections and to propose a detailed classification. The prospective study included 67 patients who were referred to CT for various indications. High-resolution CT examinations (1.5-mm collimation) were obtained through the region of the minor fissure. The CT scans were assessed for the presence, completeness, and configuration of the minor fissure. Various configurations of the minor fissure were classified into four major types, based on whether the highest portion of the middle lobe upper surface was medial (type I), lateral (type II), posterior (type III), or central (type TV). Minor fissure was identified in 65 (97%) of 67 patients, and absent in 2 (3%) cases. The fissure was incomplete in 35 (54%) of 65 patients. Type-I minor fissure is seen in 28 (43%) patients, type II in 22 (34%), type III in 5 (8%), and type IV in 2 (3%) patients. Because the majority of the fissure was absent in 8 (12%) of 35 patients with incomplete fissure, they were considered indeterminate. Comprehensive knowledge of the various configurations of the minor fissure is helpful in correct localization of a lesion and its extension. In equivocal cases, limited thin-section CT scans through the fissure delineate the anatomy more clearly and provide greater degree of precision in localizing pulmonary lesions

classification

The aims of this study were to investigate the anatomy of the minor fissure and its variations on high-resolution CT (HRCT) sections and to propose a detailed classification. The prospective study included 67 patients who were referred to CT for various indications. High-resolution CT examinations (1.5-mm collimation) were obtained through the region of the minor fissure. The CT scans were assessed for the presence, completeness, and configuration of the minor fissure. Various configurations of the minor fissure were classified into four major types, based on whether the highest portion of the middle lobe upper surface was medial (type I), lateral (type II), posterior (type III), or central (type TV). Minor fissure was identified in 65 (97%) of 67 patients, and absent in 2 (3%) cases. The fissure was incomplete in 35 (54%) of 65 patients. Type-I minor fissure is seen in 28 (43%) patients, type II in 22 (34%), type III in 5 (8%), and type IV in 2 (3%) patients. Because the majority of the fissure was absent in 8 (12%) of 35 patients with incomplete fissure, they were considered indeterminate. Comprehensive knowledge of the various configurations of the minor fissure is helpful in correct localization of a lesion and its extension. In equivocal cases, limited thin-section CT scans through the fissure delineate the anatomy more clearly and provide greater degree of precision in localizing pulmonary lesions