• Korean Journal of Radiology
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• 제20권1호
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• pp.114-125
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• 2019

Objective: Segmented cardiac cine magnetic resonance imaging (MRI) is the gold standard for cardiac ventricular volumetric assessment. In patients with difficulty in breath-holding or arrhythmia, this technique may generate images with inadequate quality for diagnosis. Real-time cardiac cine MRI has been developed to address this limitation. We aimed to assess the performance of retrospective electrocardiography-gated real-time cine MRI at 3T for left ventricular (LV) volume and mass measurement. Materials and Methods: Fifty-one patients were consecutively enrolled. A series of short-axis cine images covering the entire left ventricle using both segmented and real-time balanced steady-state free precession cardiac cine MRI were obtained. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass were measured. The agreement and correlation of the parameters were assessed. Additionally, image quality was evaluated using European CMR Registry (Euro-CMR) score and structure visibility rating. Results: In patients without difficulty in breath-holding or arrhythmia, no significant difference was found in Euro-CMR score between the two techniques (0.3 ± 0.7 vs. 0.3 ± 0.5, p > 0.05). Good agreements and correlations were found between the techniques for measuring EDV, ESV, EF, SV, and LV mass. In patients with difficulty in breath-holding or arrhythmia, segmented cine MRI had a significant higher Euro-CMR score (2.3 ± 1.2 vs. 0.4 ± 0.5, p < 0.001). Conclusion: Real-time cine MRI at 3T allowed the assessment of LV volume with high accuracy and showed a significantly better image quality compared to that of segmented cine MRI in patients with difficulty in breath-holding and arrhythmia.

• Investigative Magnetic Resonance Imaging
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• 제23권2호
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• pp.100-113
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• 2019

Sarcoidosis is a multisystem disease characterized by noncaseating granulomas. Cardiac involvement is known to have poor prognosis because it can manifest as a serious condition such as the conduction abnormality, heart failure, ventricular arrhythmia, or sudden cardiac death. Although early diagnosis and early treatment is critical to improve patient prognosis, the diagnosis of CS is challenging in most cases. Diagnosis usually relies on endomyocardial biopsy (EMB), but its diagnostic yield is low due to the incidence of patchy myocardial involvement. Guidelines for the diagnosis of CS recommend a combination of clinical, electrocardiographic, and imaging findings from various modalities, if EMB cannot confirm the diagnosis. Especially, the role of advanced imaging such as cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET), has shown to be important not only for the diagnosis, but also for monitoring treatment response and prognostication. CMR can evaluate cardiac function and fibrotic scar with good specificity. Late gadolinium enhancement (LGE) in CMR shows a distinctive enhancement pattern for each disease, which may be useful for differential diagnosis of CS from other similar diseases. Effectively, T1 or T2 mapping techniques can be also used for early recognition of CS. In the meantime, PET can detect and quantify metabolic activity and can be used to monitor treatment response. Recently, the use of a hybrid CMR-PET has introduced to allow identify patients with active CS with excellent co-localization and better diagnostic accuracy than CMR or PET alone. However, CS may show various findings with a wide spectrum, therefore, radiologists should consider the possible differential diagnosis of CS including myocarditis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Radiologists should recognize the differences in various diseases that show the characteristics of mimicking CS, and try to get an accurate diagnosis of CS.

• Investigative Magnetic Resonance Imaging
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• 제25권4호
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• pp.252-265
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• 2021

Cardiac magnetic resonance imaging (MRI) serves as a clinical gold-standard non-invasive imaging technique for the assessment of global and regional cardiac function. Conventional cardiac MRI is limited by the long acquisition time, the need for ECG gating and/or long breathhold, and insufficient spatiotemporal resolution. Real-time cardiac cine MRI refers to high spatiotemporal cardiac imaging using data acquired continuously without synchronization or binning, and therefore of potential interest in overcoming the limitations of conventional cardiac MRI. Novel acquisition and reconstruction techniques must be employed to facilitate real-time cardiac MRI. The goal of this study is to discuss methods that have been developed for real-time cardiac MRI. In particular, we classified existing techniques into two categories based on the use of non-iterative and iterative reconstruction. In addition, we present several research trends in this direction, including deep learning-based image reconstruction and other advanced real-time cardiac MRI strategies that reconstruct images acquired from real-time free-breathing techniques.

• Korean Journal of Radiology
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• 제20권5호
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• pp.695-708
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• 2019

Atrial fibrillation (AF) is the most common arrhythmia associated with the risk of morbidity and mortality in clinical patients. AF is considered as an arrhythmia type that develops and progresses through close connection with cardiac structural arrhythmogenic substrates. Since the introduction of catheter ablation-mediated electrical isolation of arrhythmogenic substrates, cardiac imaging indicates improved treatment outcome and prognosis with appropriate candidate selection, ablation catheter guidance, and post-ablation follow-up. Currently, cardiac computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging are essential in the case management of AF at both pre-and post-procedural stages of catheter ablation. In this review, we discuss the roles and technical considerations of CCT and CMR imaging in the management of patients with AF undergoing catheter ablation.

• Investigative Magnetic Resonance Imaging
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• 제23권4호
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• pp.395-400
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• 2019

Acromegaly is a rare endocrine disorder caused by excessive secretion of the growth hormone. There is a wide range of clinical manifestations from somatic symptoms to respiratory or cardiac failure. Among them, cardiovascular involvement is a leading cause of morbidity and mortality. There are relatively few cases reporting cardiac magnetic resonance imaging (CMR) findings of cardiomyopathy in patients with acromegaly. Thus, we report a case of acromegaly showing dilated cardiomyopathy focusing on the findings of CMR.

• Korean Journal of Radiology
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• 제22권12호
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• pp.1946-1963
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• 2021

Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (CMR) can reveal the detailed anatomy and function of the tricuspid valve and right ventricle (RV). Quantification of tricuspid regurgitation (TR) and analysis of RV function have prognostic implications. With the recently available transcatheter treatment options for diseases of the tricuspid valve, evaluation of the tricuspid valve using CT and CMR has become important in terms of patient selection and procedural guidance. Moreover, CT enables post-procedural investigation of the causes of valve dysfunction, such as pannus or thrombus. This review describes the anatomy of the tricuspid valve and CT and CMR imaging protocols for right heart evaluation, including RV function and TR analyses. We also demonstrate the pre-procedural planning for transcatheter treatment of TR and imaging of postoperative complications using CT.

• Investigative Magnetic Resonance Imaging
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• 제11권1호
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• pp.1-9
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• 2007

심장의 영상화에 장애가 되는 요인은 심장 운동, 호흡, 심장 내 혈류 등에 의한 인공물(artifact) 과 심장 조직의 용적이 작음으로 인한 낮은 신호 대 잡음비 등이 있다. 심장 운동에 의한 화질 저하를 막기 위해 신속영상기법(fast imaging technique) 을 이용하여 심장 운동의 특정 위상(phase) 에서만 영상을 얻는 심장동기(cardiac gating) 방법을 이용하고 있다. MRI를 이용한 심장의 검사는 심장의 형태, 심실 기능, 심근 관류, 심근 대사, 관상동맥 영상 등을 대상으로 한다. 심장의 형태적 진단에 있어서 심근내 수분의 정도와 지방조직을 보기 위해 이중(double) 혹은 삼중역전회복기법(triple inversion recovery technique) 을 사용한다. 심근관류검사를 위해서는 조영증강신속경사에코법(contrast-enhanced fast gradient echo technique)을 사용하여 일차통과조영증강(first-pass enhancement) 을 검사한다. 또한 10-15분 지연영상을 얻어 심근내 조영제의 재분포를 검사하여 만성심근경색 등의 심근파괴부위를 확인한다. 심실기능 평가를 위해서는 신속경사에 코법을 이용한 영화영상(cine image) 이 사용되며 심실의 국소적 운동이상 및 심실기능의 정량적 검사가 가능하다. MRI는 관상동맥영상을 제외한 포괄적 심장검사에 실용성이 있다. 특히 지연영상은 다른 검사장비에선 얻을수 없는 유용한 정보이다.

• Korean Journal of Radiology
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• 제24권12호
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• pp.1200-1220
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• 2023

Dilated cardiomyopathy (DCM) is one of the most common types of non-ischemic cardiomyopathy. DCM is characterized by left ventricle (LV) dilatation and systolic dysfunction without coronary artery disease or abnormal loading conditions. DCM is not a single disease entity and has a complex historical background of revisions and updates to its definition because of its diverse etiology and clinical manifestations. In cases of LV dilatation and dysfunction, conditions with phenotypic overlap should be excluded before establishing a DCM diagnosis. The differential diagnoses of DCM include ischemic cardiomyopathy, valvular heart disease, burned-out hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, and non-compaction. Cardiac magnetic resonance (CMR) imaging is helpful for evaluating DCM because it provides precise measurements of cardiac size, function, mass, and tissue characterization. Comprehensive analyses using various sequences, including cine imaging, late gadolinium enhancement imaging, and T1 and T2 mapping, may help establish differential diagnoses, etiological work-up, disease stratification, prognostic determination, and follow-up procedures in patients with DCM phenotypes. This article aimed to review the utilities and limitations of CMR in the diagnosis and assessment of DCM.

• 대한영상의학회지
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• 제82권2호
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• pp.429-434
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• 2021

아밀로이드증은 세포 외 공간에 비정상적인 단백질이 축적되는 것을 특징으로 하는 전신 질환이며, 심근을 포함한 다양한 기관을 침범한다. 저자들은 심장 아밀로이드증 환자에서 항암 화학 요법 및 줄기세포 이식 후 심장 자기공명영상의 추적검사에서 조영 전 T1 및 T2 수치와 세포 외 부피 분율의 감소를 보인 사례를 보고한다. 조영 전 T1 이완시간 및 세포 외 부피 분율은 아밀로이드증 환자에서 조직의 아밀로이드 축적 정도와 밀접한 관련이 있다. 이 사례를 통해 T1 지도화 심장 자기공명영상 기법이 심장 아밀로이드증의 치료 반응 모니터링에 비침습적이며 정량적인 도구로서 큰 역할을 할 수 있는 가능성을 확인할 수 있다.

• Korean Journal of Radiology
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• 제20권6호
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• pp.1001-1002
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• 2019