Retrospective analysis of magnetic resonance myocardial delayed enhancement.
OBJECTIVE
To explore the imaging and related clinical characteristics of magnetic resonance (MR) delayed enhancement in patients with ischemic or nonischemic heart disease.


METHODS
Thirty-two cases who underwent MR myocardial cine and delayed enhancement imaging from January 2004 to October 2006 were retrospectively analyzed. The cine sequence imaging included the four-chamber view and the left ventricular short axis view. The delayed enhancement imaging was taken 10 minutes after the infusion of gadolinium from the antecubital vein with a segmented inversion-recovery-prepared T1-weighted fast gradient echo sequence. Patients underwent coronary computed tomography angiography (CTA) two weeks before or after the MR imaging examination. Combined with clinical history, the clinical and MR imaging characteristics of the patients who had delayed enhancement were analyzed.


RESULTS
MR delayed enhancement could be found in 16 cases. Among them, 12 cases had ischemic heart disease. Their coronary CTA showed one to three vessel diseases. The delayed enhancement was transmural or subendocardium, and the area of delayed enhancement corresponded well with one or more coronary arteries which had severe stenosis or occlusion. Four cases had nonischemic heart diseases. One case was dilated cardiomyopathy, with diffuse small midwall spots in delayed enhancemen and only 30% stenosis of the anterior descending coronary artery in coronary CTA. One case was hypertrophic cardiomyopathy, with delayed enhancement of strip- and patch-shaped at midwall of the hypertrophic myocardium. One case was restrictive cardiomyopathy, and the delayed enhancement was located in the area of subendocardium of both the right and left ventricles. Coronary CTA of these two cases were normal. The other case was a mass of the lateral wall of the left ventricle, and the delayed enhancement with a clumpy shape was located in the lateral wall of the left ventricle.


CONCLUSIONS
MR myocardial delayed enhancement is not a specific sign of myocardial infarction of ischemic heart disease. Nonischemic heart diseases including all kinds of primary cardiomyopathy and some other diseases affecting myocardium can also cause delayed enhancement, but their characteristics are different. The differentiation of the etiology of the nonischemic heart disease with delayed enhancement relies upon the intimate connection with clinical history and the cine sequence MR images.
Zhang
Zhu-Hua
ZH
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730.
Miao
Qi
Q
Lin
Song-Bai
SB
Zhang
Shu-Yang
SY
Li
Dong-Jing
DJ
Chen
Li-Bo
LB
Zhang
Heng
H
Wang
Yi-Ning
YN
Zhou
Lu
L
Kong
Lin-Yan
LY
Feng
Feng
F
You
Hui
H
Sun
Hong-Yi
HY
Zhao
Wen-Min
WM
Zhang
Li-Ren
LR
Jin
Zheng-Yu
ZY
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002313:Cardiomyopathy, Restrictive / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods