Type:
Educational Exhibit
Keywords:
Diagnostic procedure, MR, Cardiovascular system, Cardiac, Blood
Authors:
V. Ojha, K. P. Ganga, G. S. Gulati, S. Seth; New Delhi/IN
DOI:
10.26044/ecr2019/C-2049
Findings and procedure details
We did a retrospective evaluation of the cardiac MRI scans of 12 biopsy proven cases of cardiac amyloidosis.
Cardiac MRI was done on a 1.5T/3T scanner.
Sample included 5 males and 7 females.
The TIS sequence was run on a 8 mm thick,
short axis mid ventricle slice (Flip angle 50°,TI increments from 64 to 695 ms),
15 minutes after contrast injection.
Due to the inhomogeneous pattern of nulling of the myocardium,
the null point of myocardium was considered as optimal when more then 50 % of the myocardium was nulled.
The time at which the spleen was maximally nulled was considered to be the optimal splenic null point.
The time (in ms) of the blood pool nulling,
myocardial nulling and splenic nulling was noted to determine the temporal sequence of nulling.
The different types of nulling patterns prevalent in patients with cardiac amyloidosis were identified and are described below.
Type 2 pattern (Fig.
2 and 3) was seen in 4/12 patients,
type 3 pattern (Fig.
4) was seen in 1/12 patients and type 4 pattern (Fig.
5 and 6) was seen in was seen in 7/12 patients.
Type 4 was the most prevalent pattern in our cohort.
It has been shown by other authors that nulling pattern is time dependent (time from post contrast injection) and may be related to myocardial amyloid load,
which could be the reason for identifying variable patterns of nulling at differing time of acquisition of post contrast injection.It was shown that only 58 % of patients with amyloidosis demonstrated a reversed nulling pattern at 5 minutes whereas upto 90 % of patients showed a reversed nulling pattern at 10 minutes with one patient showing a normal nulling pattern (3).
Hence,
this study specifically studied the nulling patterns at 15 minutes and demonstrated that no patient of amyloidosis demonstrated a normal nulling pattern.
Type 1 nulling pattern was not found in any patient suggesting a 100 % negative predictive value of this pattern if identified,
in ruling out the diagnosis of amyloidosis.