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 'Myocardial Late Enhancement' 
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Myocardial Late Enhancement
 
(LE) Myocardial late enhancement in contrast enhanced cardiac MRI has the ability to precisely delineate myocardial scar associated with coronary artery disease. Viability imaging implies evaluating infarcted myocardium to see whether there is enough viable tissue available for revascularization. The reversal of myocardial dysfunction is particularly relevant in patients with depressed ventricular function because revascularization improves long-term survival. In comparison to SPECT and PET imaging, myocardial late enhancement MRI demonstrates areas of delayed enhancement exactly in correlation with the infarcted region.
Viability on cardiac MRI (CMR) is based on the fact that all infarcts enhance vividly 10-15 minutes after the administration of intravenous paramagnetic contrast agents. This enhancement represents the accumulation of gadolinium in the extracellular space, due to the loss of membrane integrity in the infarcted tissue. This phenomenon of delayed hyperenhancement has been proven to correlate with the actual extent of the infarct.
MRI myocardial late enhancement can quantify the size, location and transmural extent of the infarct. If the transmural extent of the infarct (region of enhancement on MRI) is less than 50% of the wall thickness, there will be improved contractility in that segment following revascularization. In areas of hypokinesia, if there is a rim of "black" or non-infarcted myocardium that is not contracting well, it indicates the presence of hibernating myocardium, which is likely to improve after revascularization of the artery supplying that particular territory.
The total duration of a myocardial late enhancement MR imaging protocol for viability is approximately 30 minutes, including scout images, first-pass images, cine images in two planes, and delayed myocardial enhancement images. In order to assess viable myocardium, the gadolinium contrast agent is injected at a dose of 0.15 to 0.2 mmol/kg. After about 10 minutes, short axis and long axis views (see cardiac axes) of the heart are obtained using an inversion prepared ECG gated gradient echo sequence. The inversion pulse is adjusted to suppress normal myocardium. Areas of nonviable myocardium retain extremely high signal intensity, black areas show normal tissue.

For Ultrasound Imaging (USI) see Myocardial Contrast Echocardiography at US-TIP.com.
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• Related Searches:
    • Cardiac MRI
    • Displacement Encoding with Stimulated Echoes
    • Cardiovascular Imaging
    • Heart MRI
    • Perfusion Imaging
 
Further Reading:
  Basics:
A Guide To Cardiac Imaging
   by www.simplyphysics.com    
  News & More:
The heart reacts in two distinct phases after myocardial
Saturday, 22 November 2014   by www.betawired.com    
Prediction of Myocardial Viability by MRI
1999   by circ.ahajournals.org    
Geron Demonstrates hESC-derived cardiomyocytes improve heart function after myocardial infarction
Monday, 27 August 2007   by www.brightsurf.com    
Searchterm 'Myocardial Late Enhancement' was also found in the following service: 
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Radiology  (2) Open this link in a new window
Cardiac MRIForum -
related threads
 
In the last years, cardiac MRI techniques have progressively improved. No other noninvasive imaging modality provides the same degree of contrast and temporal resolution for the assessment of cardiovascular anatomy and pathology. Contraindications MRI are the same as for other magnetic resonance techniques.
The primary advantage of MRI is extremely high contrast resolution between different tissue types, including blood. Moreover, MRI is a true 3 dimensional imaging modality and images can be obtained in any oblique plane along the true cardiac axes while preserving high temporal and spatial resolution with precise demonstration of cardiac anatomy without the administration of contrast media.
Due to these properties, MRI can precisely characterize cardiac function and quantify cavity volumes, ejection fraction, and left ventricular mass. In addition, cardiac MRI has the ability to quantify flow (see flow quantification), including bulk flow in vessels, pressure gradients across stenosis, regurgitant fractions and shunt fractions. Valve morphology and area can be determined and the severity of stenosis quantified. In certain disease states, such as myocardial infarction, the contrast resolution of MRI is further improved by the addition of extrinsic contrast agents (see myocardial late enhancement).
A dedicated cardiac coil, and a field strength higher than 1 Tesla is recommended to have sufficient signal. Cardiac MRI acquires ECG gating. Cardiac gating (ECGs) obtained within the MRI scanner, can be degraded by the superimposed electrical potential of flowing blood in the magnetic field. Therefore, excellent contact between the skin and ECG leads is necessary. For male patients, the skin at the lead sites can be shaved. A good cooperation of the patient is necessary because breath holding at the end of expiration is practiced during the most sequences.
See also Displacement Encoding with Stimulated Echoes.
For Ultrasound Imaging (USI) see Cardiac Ultrasound at US-TIP.com.

See also the related poll results: 'In 2010 your scanner will probably work with a field strength of' and 'MRI will have replaced 50% of x-ray exams by'
 
Images, Movies, Sliders:
 Infarct 4 Chamber Cine  Open this link in a new window
    

Courtesy of  Robert R. Edelman
 MVP Parasternal  Open this link in a new window
    

Courtesy of  Robert R. Edelman
 Delayed Myocardial Contrast Enhancement from Infarct  Open this link in a new window
      

Courtesy of  Robert R. Edelman
 
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• View the DATABASE results for 'Cardiac MRI' (15).Open this link in a new window


• View the NEWS results for 'Cardiac MRI' (15).Open this link in a new window.
 
Further Reading:
  Basics:
Cardiac MRI - Technical Aspects Primer
Wednesday, 7 August 2002
Prediction of Myocardial Viability by MRI
1999   by circ.ahajournals.org    
  News & More:
Validation of Thermometric Cardiac Imaging by MRI
Thursday, 26 January 2017   by www.satprnews.com    
Controlling patient's breathing makes cardiac MRI more accurate
Friday, 13 May 2016   by www.upi.com    
New technique could allow for safer, more accurate heart scans
Thursday, 10 December 2015   by www.gizmag.com    
Precise visualization of myocardial injury: World's first patient-based cardiac MRI study using 7T MRI
Wednesday, 10 February 2016   by medicalxpress.com    
Susceptibility-weighted cardiovascular magnetic resonance in comparison to T2 and T2 star imaging for detection of intramyocardial hemorrhage following acute myocardial infarction at 3 Tesla
Tuesday, 28 October 2014   by 7thspace.com    
MRI Resources 
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Contrast Enhanced MRIInfoSheet: - Contrast Agents - 
Intro, Overview, 
Characteristics, 
Types of, 
etc.MRI Resource Directory:
 - Contrast Enhanced MRI -
 
Contrast enhanced MRI is a commonly used procedure in magnetic resonance imaging. The need to more accurately characterize different types of lesions and to detect all malignant lesions is the main reason for the use of intravenous contrast agents.
Some methods are available to improve the contrast of different tissues. The focus of dynamic contrast enhanced MRI (DCE-MRI) is on contrast kinetics with demands for spatial resolution dependent on the application. DCE-MR imaging is used for diagnosis of cancer (see also liver imaging, abdominal imaging, breast MRI, dynamic scanning) as well as for diagnosis of cardiac infarction (see perfusion imaging, cardiac MRI). Quantitative DCE-MRI requires special data acquisition techniques and analysis software.
Contrast enhanced magnetic resonance angiography (CE-MRA) allows the visualization of vessels and the temporal resolution provides a separation of arteries and veins. These methods share the need for acquisition methods with high temporal and spatial resolution.
Double contrast administration (combined contrast enhanced (CCE) MRI) uses two contrast agents with complementary mechanisms e.g., superparamagnetic iron oxide to darken the background liver and gadolinium to brighten the vessels. A variety of different categories of contrast agents are currently available for clinical use.
Reasons for the use of contrast agents in MRI scans are:
Relaxation characteristics of normal and pathologic tissues are not always different enough to produce obvious differences in signal intensity.
Pathology that is sometimes occult on unenhanced images becomes obvious in the presence of contrast.
Enhancement significantly increases MRI sensitivity.
In addition to improving delineation between normal and abnormal tissues, the pattern of contrast enhancement can improve diagnostic specificity by facilitating characterization of the lesion(s) in question.
Contrast can yield physiologic and functional information in addition to lesion delineation.
Imaging of arteries and veins with contrast enhanced angiography (CE MRA).

Common Indications:
Brain MRI : Preoperative/pretreatment evaluation and postoperative evaluation of brain tumor therapy, CNS infections, noninfectious inflammatory disease and meningeal disease.
Spine MRI : Infection/inflammatory disease, primary tumors, drop metastases, initial evaluation of syrinx, postoperative evaluation of the lumbar spine: disk vs. scar.
Breast MRI : Detection of breast cancer in case of dense breasts, implants, malignant lymph nodes, or scarring after treatment for breast cancer, diagnosis of a suspicious breast lesion in order to avoid biopsy.

For Ultrasound Imaging (USI) see Contrast Enhanced Ultrasound at US-TIP.com. See also Blood Pool Agents, Myocardial Late Enhancement, Cardiovascular Imaging, Contrast Enhanced MR Venography, Contrast Resolution, Dynamic Scanning, Lung Imaging, Hepatobiliary Contrast Agents, Contrast Medium and MRI Guided Biopsy.

 
Images, Movies, Sliders:
 Delayed Myocardial Contrast Enhancement from Infarct  Open this link in a new window
      

Courtesy of  Robert R. Edelman
 Left Circumflex Ischemia First-pass Contrast Enhancement  Open this link in a new window
      

Courtesy of  Robert R. Edelman

 Normal Lung Gd Perfusion MRI  Open this link in a new window
 MRI of the Brain Stem with Temoral Bone and Auditory System  Open this link in a new window
    
SlidersSliders Overview

 Breast MRI Images T1 Pre - Post Contrast  Open this link in a new window
 
Radiology-tip.comContrast Enhanced Computed Tomography
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Radiology-tip.comContrast Enhanced Ultrasound,  Contrast Enhanced Doppler Imaging
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• View the DATABASE results for 'Contrast Enhanced MRI' (14).Open this link in a new window


• View the NEWS results for 'Contrast Enhanced MRI' (8).Open this link in a new window.
 
Further Reading:
  Basics:
Optimal k-Space Sampling for Dynamic Contrast-Enhanced MRI with an Application to MR Renography
Thursday, 5 November 2009   by www.ncbi.nlm.nih.gov    
Background MRI Enhancement Up in Premenopausal Breast Cancer
Friday, 7 June 2013   by www.doctorslounge.com    
Bringing innovative technologies together
Monday, 18 November 2013   by www.european-hospital.com    
  News & More:
The Effects of Breathing Motion on DCE-MRI Images: Phantom Studies Simulating Respiratory Motion to Compare CAIPIRINHA-VIBE, Radial-VIBE, and Conventional VIBE
Tuesday, 7 February 2017   by www.kjronline.org    
MRI Contrast Agent Analysis from Bruker
Sunday, 11 August 2013   by www.azom.com    
CMC Contrast Granted Orphan Drug Designation by the FDA for its Liver Specific MRI Contrast Media CMC-001
Wednesday, 27 November 2013   by news.gnom.es    
All-organic MRI Contrast Agent Tested In Mice
Monday, 24 September 2012   by cen.acs.org    
A groundbreaking new graphene-based MRI contrast agent
Friday, 8 June 2012   by www.nanowerk.com    
Novel Imaging Technique Improves Prostate Cancer Detection
Tuesday, 6 January 2015   by health.ucsd.edu    
New oxygen-enhanced MRI scan 'helps identify most dangerous tumours'
Thursday, 10 December 2015   by www.dailymail.co.uk    
MRI Resources 
Brain MRI - MRI Centers - Crystallography - Collections - Equipment - Bioinformatics
 
Displacement Encoding with Stimulated EchoesInfoSheet: - Sequences - 
Intro, 
Overview, 
Types of, 
etc.
 
(DENSE) Displacement Encoding with Stimulated Echoes is a functional cardiac MRI pulse sequence, used to create maps of myocardial displacement with high resolution.
The DENSE magnitude images produce black blood images to show better myocard-blood contrast and to reduce motion artifacts.
See also Myocardial Late Enhancement, Spin Tagging, Coronary Angiography with D-Tagging, Cardiovascular Imaging, and Black Blood MRA.
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• View the DATABASE results for 'Displacement Encoding with Stimulated Echoes' (2).Open this link in a new window

 
Further Reading:
  Basics:
Latest Pulse Sequence for Displacement-encoded MR Imaging Incorporates Essential Technical Improvements for Multiphase Measurement of Intramyocardial Strain
March 2004   by radiology.rsna.org    
Searchterm 'Myocardial Late Enhancement' was also found in the following service: 
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Radiology  (2) Open this link in a new window
Heart MRI
 
Magnetic resonance imaging of the heart is a diagnostic MRI procedure that is useful to evaluate the structures, the function and viability of the heart and the major blood vessels.
See also Cardiac MRI, Cardiovascular Imaging, MRA, Cardiac Stent, Myocardial Late Enhancement and Coronary Angiography.
Radiology-tip.comHeart Scintigraphy,  Coronary CT Angiography
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Radiology-tip.comCardiac Ultrasound,  Echocardiography
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• View the NEWS results for 'Heart MRI' (18).Open this link in a new window.
 
Further Reading:
  Basics:
Advanced Imaging Can ID More Causes Of Stroke Before They Strike
Thursday, 22 March 2007   by www.sciencedaily.com    
New technique could allow for safer, more accurate heart scans
Thursday, 10 December 2015   by www.gizmag.com    
  News & More:
Validation of Thermometric Cardiac Imaging by MRI
Thursday, 26 January 2017   by www.satprnews.com    
MRI shows heart ages differently in women than in men
Tuesday, 20 October 2015   by www.eurekalert.org    
Tiny Brain Blocks as Marker for Heart Disease Too?
Monday, 6 February 2017   by www.medpagetoday.com    
Brains Of Term Infants With Heart Disease Resemble Those Of Preemies
Monday, 12 November 2007   by www.sciencedaily.com:80    
MRI Resources 
Fluorescence - Supplies - Case Studies - Lung Imaging - MRI Technician and Technologist Schools - Knee MRI
 
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