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Late gadolinium enhancement (LGE) and T1 mapping allow infarction and fibrosis to be identified for characterizing cardiomyopathy and assessing viability. [8] Magnetic resonance angiography may be performed with or without contrast medium and is used to assess congenital or acquired abnormalities of the coronary arteries and great vessels. [9]
Gadolinium(III) containing MRI contrast agents (often termed simply "gado" or "gad") are the most commonly used for enhancement of vessels in MR angiography or for brain tumor enhancement associated with the degradation of the blood–brain barrier (BBB). [3] [4] Over 450 million doses have been administered worldwide from 1988 to 2017. [5]
Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis; Delayed Gadolinium-enhanced MR to Determine Glycosaminoglycan Concentration in Reparative Cartilage after Autologous Chondrocyte Implantation: Preliminary Results
Additional benefits from cardiac MRI include the ability to detect scar within the heart using late gadolinium enhancement, and identify other abnormalities of the heart muscle itself such as infiltration with iron or amyloid protein. [11] Disadvantages of MRI include lengthy protocols and the potential for claustrophobia.
Late gadolinium enhancement on cardiac MRI demonstrates perturbations in extracellular volume as a result of cell necrosis or edema, and is significantly associated with increases in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
The contrast agents used for DCE-MRI are often gadolinium based. Interaction with the gadolinium (Gd) contrast agent (commonly a gadolinium ion chelate) causes the relaxation time of water protons to decrease, and therefore images acquired after gadolinium injection display higher signal in T1-weighted images indicating the present of the agent.
Cardiac MRI may find pericardial thickening and pericardial-myocardial adherence. Ventricular septum shift during breathing can also be found using cardiac MRI. Late gadolinium enhancement can show enhancement of the pericardium due to fibroblast proliferation and neovascularization.
Late-gadolinium enhancement on cardiac MRI indicates the presence of fibrosis and scarring, and may be evidence of cardiomyopathy not due to tachycardia. [ 1 ] [ 5 ] A decline in serial NT-pro BNP with control of tachyarrhythmia indicates reversibility of the cardiomyopathy, which would also suggest TIC.