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Innovative Techniques in CMR
Spezialkurs: Interpretation – Stress-Perfusion
Spezialkurs: Parametrisches Mapping
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Case Book
Fallsammlung
März 26, 2019
Case Book
First name and last name
Case 1
34-year-old male with acute myocarditis and preserved LV function (EF 55%)
The red arrow shows:
1. STIR (TIRM) in SAX (short axis) with evidence of myocardial edema lateral
2. Late Gadolinium Enhancement (LGE) in SAX with subepicardial scar / fibrosis lateral
Case 2
A 75-year-old female patient with suspicion of amyloidosis and mild impaired LV function (EF 52%)
Figure „A“ shows:
1. SSFP (steady state precession sequence) Cine in 2 chamber view
2. Late Gadolinium Enhancement (LGE) with pathognomonic pattern of a cardiac amyloidosis
Case 3
76-year-old woman with atypical thoracic pain and preserved systolic LV function without wall motion abnormalities.
Example: adenosine perfusion exam performed without rest-perfusion.
Figure „B“ shows:
1. Normal adenosine-stress-perfusion
2. Stress-induced perfusion defect mostly septal
3. Stress-induced perfusion defect mostly anterior
Case 4
69-year-old man with progressive dyspnea and dilated left ventricle in ECHO
Figures show:
1. Aortic valve insufficiency and tricuspid aortic valve
2. Aortic valve insufficiency and bicuspid aortic valve
3. Aortic stenosis and bicuspid aortic valve
4. Mitral valve insufficiency
Case 5
67-year-old woman with acute thoracic pain
The red arrow shows:
1. Pericardial effusion
2. Pericardial cyst
3. Pleural effusion
Case 6
76-year-old woman with typical thoracic pain and progressive dyspnea since 4-6 months
In ECHO suspected aortic valve stenosis
Figure „C“ shows:
1. Tricuspid aortic valve
2. Bicuspid aortic valve
3. Aortic dissection
Case 7
48-year-old man with acute (antero-anteroseptal) myocardial infarction and preserved LV function, EF 57%
Figure „B“ shows:
1. T2-weighted images with evidence of myocardial edema
2. T1-weighted images with evidence of myocardial edema
3. Artifact
4. Late Gadolinium Enhancement (LGE) with transmural scar/fibrosis
Case 8
The same patient, 48-year-old man with acute (antero/ anteroseptal) myocardial infarction and preserved LV function, EF 57%
Figure „A“ shows:
1. Late Gadolinium Enhancement (LGE) in 3 chamber view and transmural scar/fibrosis within infarct area
2. Late Gadolinium Enhancement (LGE) in 3 chamber view with microvascular obstruction within infarct area
3. T1-weighted images in short axis with evidence of myocardial edema within infarct area
4. Normal Late Gadolinium Enhancement (LGE)
Case 9
54-year-old woman with progressive dyspnea and unexplained structure in echocardiography
Figure A: 3-chamber view; SSFP cine; mass in the left atrium
Figure B: 4-chamber view; T2-weighted image mass with hyperintense signal comparison to the myocardium
Figure C: 2-chamber view; Late Gadolinium Enhancement mass with isointense in comparison to the myocardium
The findings are highly suspected to be a:
1. myxoma
2. lipoma
3. thrombus
4. fibroelastoma
Case 10
32-year-old man with unclear palpitations and dyspnea during stress.
Family history: father- sudden cardiac death at the age of 55.
The image is typical for:
1. amyloidosis
2. hypertrophic cardiomyopathy
3. hypertensive heart disease
4. sarcoidosis
Case 11
32-year-old woman after viral infection with fever and thoracic pain
The figure shows:
1. A und B pericardial effusion
2. A- pericardial cyst; B- pericardial effusion
3. A- pleural effusion; B- epicardial fat
4. A- pleural effusion; B- pericardial effusion
Case 12
46-year-old man, smoker with poorly controlled blood pressure and progressive angina pectoris
The image shows:
1. dissection of Aorta desc
2. dissection of Aorta asc
3. dissection of abdominal Aorta
4. coarctation of the aorta
Case 13
25-year-old man with progressive dyspnea during exercise and normal coronary arteries (cath).
LV-EF 20%. End-diastolic volume index 1.6 ml/m2 (norm value: 1.2)
A typical sign for:
1. sarcoidosis
2. dilated cardiomyopathy, potentially caused by myocarditis
3. arrhythmogenic cardiomyopathy
4. non-compaction cardiomyopathy
Case 14
Late Gadolinium Enhancement images show
a typical sign of:
1. subendocardial/transmural scar/fibrosis typical for coronary heart disease
2. subepicardial/transmural scar/fibrosis typical for myocarditis
3. subepicardial/transmural scar/fibrosis typical for coronary heart disease
4. subendocardial/transmural scar/fibrosis typical for myocarditis
Case 15
28-year-old man with atypical angina pectoris and palpitations
Figures show:
1. Late Gadolinium Enhancement (LGE) in 4 chamber view and in SAX (short axis) with subepicardial scar/fibrosis lateral
2. Late Gadolinium Enhancement (LGE) in 4 chamber view und in SAX (short axis) with intramyocardial scar/fibrosis lateral
3. Late Gadolinium Enhancement (LGE) in 4 chamber view und in SAX (short axis) with subendocardial scar/fibrosis lateral
4. STIR (TIRM) in 4 chamber view und in SAX (short axis) with subendocardial scar/fibrosis lateral
Case 16
57-year-old man with acute chest pain
Figures show:
1. acute myocarditis with evidence of myocardial edema lateral in T2-weighted images
2. Late Gadolinium Enhancement (LGE) with non-ischaemic subepicardial scar/fibrosis lateral
3. subacute myocardial infarction with evidence of myocardial edema lateral in T2-weighted sequence and microvascular obstruction (MVO) in Late Gadolinium Enhancement (LGE)
4. acute myocardial infarction with evidence of myocardial edema lateral in T2-weighted technique and thrombus in Late Gadolinium Enhancement (LGE)
Case 17
46-year-old male, with known aortic valve insufficiency
Images show:
1. aneurysm oft the Aorta desc
2. aneurysm of the Aorta asc
3. abdominal aortic aneurysm
4. coarctation of the Aorta
Case 18
76-year-old woman after emotional stress, with atypical thoracic pain and troponine elevation. No coronary stenosis. The CMR image shows an apical ballooning.
The images are typical for:
1. Dilated cardiomyopathy
2. Tako-Tsubo cardiomyopathy
3. Amyloidosis
4. Thrombus
Case 19
47-year-old man after heart attack 4 months ago and apical acinesia
The arrow shows:
1. Late Gadolinium Enhancement (LGE) and microvascular obstruction (MVO)
2. apical thrombus
3. Slow Flow in T2-weighted images
Case 20
64-year-old man with typical thoracic pain and preserved systolic LV function.
Adenosine perfusion.
The arrow shows:
1. Stress-induced perfusion defect mostly lateral
2. Stress-inducted perfusion defect septal/anterosetal
3. Stress-induced perfusion defect mostly inferior
4. Dark rim artefakt
Case 21
The white arrows on 4CV-Cine image („A“) indicate a right heart dilatation.
The red arrow on Cine image („B“) – short axis - shows a „D-Sign“.
These changes are pathognomonic for
1. arrhythmogenic cardiomyopathy
2. right ventricular pressure overload
3. myocardial infarction with right-sided localization
Case 22
The red arrow shows:
1. tricuspid aortic valve
2. bicuspid aortic valve
3. mitral valve stenosis
4. pulmonary valve
Case 23
Late Gadolinium Enhancement (LGE) images in „A“ 2CV, „B“ short axis show:
1. Non-ischemic, subepicardial scar / fibrosis, typical for myocarditis
2. Intramyocardial scar suggestive for dilated cardiomyopathy
3. Amyloidosis
4. Ischemic subendocardial scar / fibrosis after anterior wall infarction
Case 24
To differentiate acute and chronic myocardial infarction applying CMR, the following sequences may be helpful, except:
1. Cine images with the request for wall motion abnormality
2. Late Gadolinium Enhancement(LGE) with the request for microvascular obstruction
3. T2-wighted sequence with the request for myocardial edema
4. T2-Mapping with the request for a microvascular obstruction
5. T2-wdighted sequence with the request for myocardial edema
Case 25
The white arrow shows:
1. STIR/TIRM in short axis (SAX) with evidence of myocardial edema septal / anterior
2. Late Gadolinium Enhancement (LGE) in short axis (SAX) with tramsmural scar/fibrosis lateral
3. Late Gadolinium Enhancement (LGE) in short axis (SAX), a typical image of amyloidosis
Case 26
The images show:
1. aortic insufficiency / tricuspid aortic valve
2. aortic insufficiency / bicuspid aortic valve
3. mitral valve insufficiency
5. aortic valve stenosis
Case 27
The images show:
1. tricuspid aortic valve stenosis with aortic dilatation
2. bicuspid aortic valve stenosis with aortic dilatation
3. mitral valve stenosis
4. pulmonal valve stenosis
Case 28
The figure above shows:
1. Fabry disease
2. Non-compaction cardiomyopathy
3. apical form of hypertrophic cardiomyopathy
4. LV-tumor
Case 29
The arrows show:
1. dilatation of the Aorta asc
2. dilatation of the Aorta desc
3. left atrium
4. main pulmonary artery
Case 30
Continuation of case no. 29
Images above show:
1. Tetracuspide pulmonary valve
2. Tetracuspide mitral valve
3. Tetracuspide aortic valve
4. Tetracuspide tricuspid valve
Time is Up!
Enrico_meART
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