Kardiyak Manyetik Rezonans Görüntülemede Geç Faz Kontrastlanmanın Önemi
Özet
Kardiyak manyetik rezonans görüntüleme giderek yaygınlaşmakta ve hastalıkların ayırıcı tanısında önemli bir silah olarak kullanılmaktadır. Geç faz kontrastlanma (LGE) görüntüleme doku karakterizasyonu yaparak fibrozis saptamada kullanılan temel bir sekanstır. Diğer kontrastlı sekanslara göre kilograma göre verilen kontrast madde miktarı iki kat kadar fazla ve 10. Dakikadan sonra görüntüleme gerçekleştirilmesidir. Ayrıca miyokardın baskılanma süresinin kullanıldığı invertion time (TI) scout ve PSIR gibi özel sekanslar geliştirilmiştir. Phase-sensitive inversion recovery (PSIR) sekanslar miyokardda kontrast tutulum paternlerine göre kardiyomiyopatilerin ayrıcı tanısında oldukça faydalıdır. Ayrıca hastalığın prognozu açısından da fikir vermektedir. Bu bölümde LGE görüntüleme tekniğinden ve kardiyomiyopatilerin ayırıcı tanısındaki öneminden bahsedilecektir. Başlıca miyokardit, hipertrofik kardiyomiyopati, dilate kardiyomiyopati, nondilate sol ventrikül kardiyomiyopatisi, iskemik kardiyomiyopati, aritmojenik kardiyomiyopati, kardiyak amiloidoz ve fabry hastalığında sık görülen LGE paternlerinden bahsedilecektir.
Referanslar
Sanz J, LaRocca G, Mirelis JG. Myocardial Mapping With Cardiac Magnetic Resonance: The Diagnostic Value of Novel Sequences. Revista Española de Cardiología (English Edition). 2016;69:849-61.
Arbelo E, Protonotarios A, Gimeno JR, et al. 2023 ESC Guidelines for the management of cardiomyopathies: Developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC). Eur Heart J. 2023;44:3503-626.
Aquaro GD, De Gori C, Faggioni L, et al. Diagnostic and prognostic role of late gadolinium enhancement in cardiomyopathies. Eur Heart J Suppl. 2023;25:130.
Jenista ER, Wendell DC, Azevedo CF, et al. Revisiting how we perform late gadolinium enhancement CMR: insights gleaned over 25 years of clinical practice. Journal of Cardiovascular Magnetic Resonance. 2023;25:18.
Andreu D, Ortiz-Pérez JT, Fernández-Armenta J, et al. 3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation. Europace 2015;17:938-45.
Bietenbeck M, Florian A, Shomanova Z, et al. Novel CMR techniques enable detection of even mild autoimmune myocarditis in a patient with systemic lupus erythematosus. Clinical Research in Cardiology. 2017;106:560–3.
Ferreira VM, Schulz-Menger J, Holmvang G, et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 2018;72:3158-76.
Baxi AJ, Restrepo CS, Vargas D, et al. Hypertrophic cardiomyopathy from A to Z: Genetics, pathophysiology, imaging, and management. Radiographics. 2016;36:335-54.
Amio A, Todiere G, Barison A, et al. Diagnosis and Management of Hypertrophic Cardiomyopathy: European vs. American guidelines. Heart Fail Rev 2025; 30:315–325.
Viliani D, Pozo E, Aguirre N, et al. Helical distribution of hypertrophy in patients with hypertrophic cardiomyopathy: prevalence and clinical implications. International Journal of Cardiovascular Imaging. 2017;33:1771-80.
Tao J, Duan F, Long J, et al. The Role of the Submitral Apparatus in Hypertrophic Obstructive Cardiomyopathy. Journal of the American Society of Echocardiography. 2023;36:133-45.
Chan RH, Maron BJ, Olivotto I, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014;130:484-95.
Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. Journal of Clinical Medicine. 2022;11:578.
Chan RH, Maron BJ, Olivotto I, et al. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation. 2014;130:484-95.
Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of Thoracic and Cardiovascular Surgery. 2021;162:23-106.
Sparrow PJ, Merchant N, Provost YL, et al. CT and MR imaging findings in patients with acquired heart disease at risk for sudden cardiac death. Radiographics. 2009;29:805-23.
Di Marco A, Anguera I, Schmitt M, et al. Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis. JACC Heart Fail. 2017;5:28-38.
Bietenbeck M, Meier C, Korthals D, et al. Possible Causes and Clinical Relevance of a “Ring-Like” Late Gadolinium Enhancement Pattern. Cardiovascular Imaging. 2024;17:104-6.
Baritussio A, Scatteia A, Bucciarelli-Ducci C. Role of cardiovascular magnetic resonance in acute and chronic ischemic heart disease. International Journal of Cardiovascular Imaging. 2018;34:67-80.
Edvardsen T, Asch FM, Davidson B, et al. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr. 2022;16:362-83.
Kim RJ, Wu E, Rafael A, et al. The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction. New England Journal of Medicine. 2000;343:1445-53.
Flavian A, Carta F, Thuny F, et al. Cardiac MRI in the diagnosis of complications of myocardial infarction. Diagn Interv Imaging. 2012;93:578-85.
Corrado D, Perazzolo Marra M, Zorzi A, et al. Diagnosis of arrhythmogenic cardiomyopathy: The Padua criteria. Int J Cardiol. 2020;319:106-14.
Tandri H, Saranathan M, Rodriguez ER, et al. Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol. 2005;45:98-103.
Fontana M, Banypersad SM, Treibel TA, et al. Native T1 mapping in transthyretin amyloidosis. JACC Cardiovasc Imaging. 2014;7:157-65.
Garcia-Pavia P, Rapezzi C, Adler Y, et al. Diagnosis and treatment of cardiac amyloidosis: A position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2021;42:1554-68.
Martinez-Naharro A, Treibel TA, Abdel-Gadir A, et al. Magnetic Resonance in Transthyretin Cardiac Amyloidosis. J Am Coll Cardiol. 2017;70:466-77.
Shah O, Choh N, Shera T, et al. Magnetic Resonance Imaging in Cardiac Amyloidosis: Unraveling the Stealth Entity. Int J Angiol. 2021;31:40.
White JA, Kim HW, Shah D, et al. CMR imaging with rapid visual T1 assessment predicts mortality in patients suspected of cardiac amyloidosis. JACC Cardiovasc Imaging. 2014;7:143-56.
Chang S, Lee WW, Chun EJ. Recent Update of Advanced Imaging for Diagnosis of Cardiac Sarcoidosis: Based on the Findings of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography. Investig Magn Reson Imaging. 2019;23:100-13.
Pieroni M, Moon JC, Arbustini E, et al. Cardiac Involvement in Fabry Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2021;77:922-36.
Aquaro GD, De Gori C, Faggioni L, et al. Cardiac Magnetic Resonance in Fabry Disease: Morphological, Functional, and Tissue Features. Diagnostics. 2022;12:2652.
Beer M, Weidemann F, Breunig F, et al. Impact of Enzyme Replacement Therapy on Cardiac Morphology and Function and Late Enhancement in Fabry’s Cardiomyopathy. Am J Cardiol. 2006;97:1515-8.
