Clinical Utility of a Slow 201Tl Washout Rate in the Detection of Multi-Vessel Coronary Artery Disease Using a Simultaneous Acquisition Rest 99 mTc/Stress 201Tl Protocol and a Semiconducting Gamma Camera.

BACKGROUND: The diagnostic accuracy of stress myocardial perfusion single-photon emission computed tomography (SPECT) to detect coronary artery disease (CAD) is reduced by the balanced reduction of myocardial perfusion in patients with multi-vessel or left main trunk CAD (multi-vessel group). This study investigated the diagnostic performance of a simultaneous acquisition rest 99 mTc/stress 201Tl dual-isotope protocol for myocardial perfusion SPECT (MPS) in a multi-vessel group by examining the assessment of a slow 201Tl washout rate (WR) finding in comparison to the accuracy of perfusion assessments.Methods and Results: This study enrolled 91 patients who had undergone angiography within 3 months after MPS. The diagnostic performances of perfusion assessments and a slow 201Tl WR parameter were compared using the area under the curve (AUC) in a multi-vessel group of patients with mild ischemia (2≤summed difference score [SDS]≤7). The AUC of a slow WR parameter was significantly larger compared with that for perfusion assessments, in patients with mild ischemia, (AUC, 0.736 vs. 0.504-0.558, P value: <0.01-0.05). CONCLUSIONS: Among patients with mild ischemia, a slow 201Tl WR parameter improved the detection of CAD in a multi-vessel group.

Localization of Late Gadolinium Enhancement and Its Association with Ventricular Tachycardia in Patients with Cardiac Sarcoidosis.

Sustained ventricular tachycardia (sVT), leading to sudden cardiac death, is one of the common manifestations in cardiac sarcoidosis (CS). Although late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been reported to be associated with sVT, the relationships of its localization to sVT have not been fully evaluated.To evaluate the localization of LGE and its relationships to sVT in patients with CS, we reviewed medical record of consecutive 31 patients with CS who underwent CMR. The localization of LGE was divided into four categories: Left ventricular (LV) septum, LV free wall, right ventricular (RV) septum, and RV free wall. We investigated the association of sVT with localization of LGE and other parameters including serum biomarkers LV ejection fraction on echocardiography and Fluorine-18-fluorodeoxyglucose (FDG) accumulation on positron emission tomography (PET) -CT.Of the studied population, 8 patients (25.8%) were known to present with sVT among 31 CS patients. LGE was observed in the RV free wall in 6 patients with sVT, whereas it was in 5 patients without sVT (75.0% versus 21.7%, P = 0.022). Univariate analysis showed that only LGE in the RV free wall was associated with sVT (odds ratio [OR]: 10.80; 95% confidence interval [CI]: 1.64-70.93, P = 0.013).LGE in the RV free wall was associated with sVT in patients with CS.

Case report of portal hepatic schwannoma: presentation of multimodality images.

BACKGROUND: Portal hepatic schwannoma is a rare benign tumor and difficult to diagnose preoperatively because of its rarity and imaging manifestations that mimic malignancy. We present a case of portal hepatic schwannoma that showed moderate contrast enhancement on computed tomography (CT), extension along the bile duct on T2-weighted imaging and magnetic resonance cholangiopancreatography (MRCP), and uptake of 18F-fluorodeoxyglucose (FDG) on positron emission tomography. CASE PRESENTATION: Ultrasonography at an annual health checkup identified a hepatic mass in a 38-year-old woman. CT showed a well-defined portal hepatic tumor with mild contrast enhancement. T2-weighted imaging and MRCP showed a clavate tumor extending along the intrahepatic bile ducts but no dilatation of the ducts. The tumor exhibited increased FDG uptake, such as maximum standardized uptake values of 5.0 and 6.5 in the early and late phases, respectively. Neither dilatation of intrahepatic bile ducts nor lymphadenopathy was identified, and the multimodality imaging suggested hepatic portal lymphoma, gastrointestinal tumor, or IgG4-related disease rather than cholangiocarcinoma. A needle biopsy via endoscopic ultrasonography was performed, and immunohistology confirmed the tumor as a schwannoma. CONCLUSIONS: The diagnosis of a portal hepatic schwannoma requires immunohistological examinations in addition to multimodality imaging studies to reflect fully the pathohistological characteristics of the tumor.

Incremental Predictive Value of Coronary Calcium Score in Risk Stratification of Coronary Revascularization in Patients With Normal or Mild Ischemia Using Nuclear Myocardial Perfusion Single Photon Emission Computed Tomography.

BACKGROUND: The incremental predictive value of the coronary artery calcium score (CACS) for risk stratification of coronary revascularization in patients with normal or mildly abnormal nuclear myocardial perfusion single photon emission computed tomography (MPS) scores is unknown.Methods and Results:We analyzed 528 patients in whom CACS was calculated and who underwent stress MPS within 3 months. Patients with known coronary artery disease, prior coronary revascularization, and those undergoing hemodialysis were excluded. Patients were followed-up with coronary revascularization based on the evidence of physiological ischemia defined by fractional flow reserve or severe coronary stenosis (≥90%). CACS was significantly associated with the summed stress score (SSS) from MPS assessment. Multivariate logistic regression analysis showed that high CACS (≥300; odds ratio [OR] 5.44, 95% confidence interval [CI] 2.28-13.0) and SSS (OR 1.29, 95% CI 1.18-1.40) were significant (P<0.001) predictors of future coronary revascularization. The log-rank test showed that high CACS stratified coronary revascularization in normal SSS (0-3; P<0.001) or mildly abnormal SSS (4-8; P=0.028) groups, whereas high CACS did not significantly stratify coronary revascularization in moderate to severe SSS (≥9; P=0.757). CONCLUSIONS: Risk stratification using CACS with a cut-off value 300 may have incremental predictive value for revascularization in patients with normal or mildly abnormal MPS.

Hybrid Assessment of Myocardial Ischemia Using Stress-Only Nuclear Myocardial Perfusion Imaging and Rest Computed Tomography Perfusion Imaging.

BACKGROUND: Sequential assessment using CT coronary angiography (coronary CT) and nuclear myocardial perfusion imaging (MPI) is considered an anatomical and functional evaluation of coronary artery disease (CAD). However, there can be unexpected radiation exposure. Hybrid MPI with stress-only nuclear MPI and rest CT-MPI using coronary CT may contribute to reducing the radiation dose in sequential assessment with nuclear MPI after coronary CT. We analyzed the diagnostic performance and total radiation dose of hybrid MPI for detection of significant CAD compared with sequential assessment using nuclear MPI after coronary CT.Methods and Results:The results for 101 patients who underwent coronary CT, nuclear MPI and invasive coronary angiography within 3 months of all imaging were analyzed. We calculated the summed difference score (SDS) from standard nuclear MPI and hybrid SDS from hybrid MPI, which revealed myocardial ischemia. The diagnostic performance of SDS and hybrid SDS for detecting significant CAD was analyzed using receiver-operating characteristic (ROC) curve analysis. We also compared the total radiation dose of both methods. The area under the ROC curve was not different between SDS and hybrid SDS (0.901 and 0.815, P=0.079). Total radiation dose of hybrid MPI was significantly lower than standard nuclear MPI with CT angiography (4.62 mSv vs. 9.72 mSv, P<0.0001). CONCLUSIONS: Hybrid MPI showed a precise diagnostic accuracy for significant CAD detection.

Multiparametric flow analysis using four-dimensional flow magnetic resonance imaging can detect cerebral hemodynamic impairment in patients with internal carotid artery stenosis.

PURPOSE: MRI-based risk stratification should be established to identify patients with internal carotid artery stenosis (ICS) who require further PET or SPECT evaluation. This study assessed whether multiparametric flow analysis using time-resolved 3D phase-contrast (4D flow) MRI can detect cerebral hemodynamic impairment in patients with ICS. METHODS: This retrospective study analyzed 26 consecutive patients with unilateral ICS (21 men; mean age, 71 years) who underwent 4D flow MRI and acetazolamide-stress brain perfusion SPECT. Collateral flow via the Willis ring was visually evaluated. Temporal mean flow volume rate (Net), pulsatile flow volume (ΔV), and pulsatility index (PI) at the middle cerebral artery were measured. Cerebral vascular reserve (CVR) was calculated from the SPECT dataset. Patients were assigned to the misery perfusion group if the CVR was < 10% and to the nonmisery perfusion group if the CVR was ≥ 10%. Parameters showing a significant difference in both groups were statistically evaluated. RESULTS: Affected side ΔV, ratio of affected to contralateral side Net (rNet), and ratio of affected to contralateral side ΔV were significantly correlated to CVR (p = 0.030, p = 0.010, p = 0.015, respectively). Absence of retrograde flow at the posterior communicating artery was observed in the misery perfusion group (p = 0.020). Combined cut-off values of the affected side ΔV (0.18 ml) and rNet (0.64) showed a sensitivity and specificity of 100% and 77.8%, respectively. CONCLUSION: Multiparametric flow analysis using 4D flow MRI can detect misery perfusion by comprehensively assessing blood flow data, including blood flow volume, pulsation, and collateral flow.

Detection of Myocardial Tissue Alterations in Hypertrophic Cardiomyopathy Using Texture Analysis of T2-Weighted Short Inversion Time Inversion Recovery Magnetic Resonance Imaging.

OBJECTIVE: The aim of this study was to evaluate the usefulness of texture analysis of T2-weighted short inversion time inversion recovery (T2-STIR) for detecting myocardial tissue alterations in hypertrophic cardiomyopathy (HCM). METHODS: Twenty patients with HCM and 11 controls were examined. Texture analysis was performed for the hypertrophied regions with and without and abnormal hyperintensity (AHI) and for the interventricular septum of the controls on T2-STIR. T2 mapping was performed to measure myocardial T2 values. RESULTS: A gray-level nonuniformity value of 64.7 was the best discriminator between patients and controls with an area under the curve of 0.93 on a receiver operating characteristic curve. T2 values did not differ between them. The gray-level nonuniformity was significantly smaller in AHI regions than in the hypertrophied regions without AHI in HCM patients. CONCLUSIONS: Texture analysis is useful for quantitatively detecting myocardial tissue altenations, including AHI, associated with HCM on T2-STIR.

Extracellular volume fraction assessed using cardiovascular magnetic resonance can predict improvement in left ventricular ejection fraction in patients with dilated cardiomyopathy.

T1 mapping using cardiac magnetic resonance (CMR) is useful for myocardial assessment. However, its prognostic value is not well defined. The aim of this study was to determine whether T1 mapping with CMR can predict reverse cardiac remodeling in patients with non-ischemic dilated cardiomyopathy (NIDCM). We also investigated the predictive prognostic value of T1 mapping with CMR in these patients. We included 33 patients with NIDCM admitted to Nippon Medical School Hospital between February 2012 and October 2015. All patients underwent CMR and echocardiography for clinical assessment within 1 month of admission (13 ± 16 days). Follow-up echocardiography was performed no sooner than 6 months after the initial echocardiogram (536 ± 304 days). We evaluated the correlations between native and post-contrast T1 values/extracellular volume fraction (ECV) and the difference in left ventricular ejection fraction (ΔLVEF) determined at baseline and follow-up echocardiography. No correlation was noted between ΔLVEF and native (p = 0.150, r = - 0.256) or post-contrast T1 values (p = 0.956, r = - 0.010). However, a significant and substantial correlation was found between ΔLVEF and ECV (p = 0.043, r = - 0.355). Four patients were hospitalized for heart failure (HF), but no cardiovascular-related deaths occurred over a median follow-up period of 34 months (interquartile range 25-49 months). Kaplan-Meier curves stratified by the median value of ECV were created. The higher ECV groups experienced a significantly higher incidence of HF-related hospitalization (p = 0.0159). ECV measured by CMR can predict improvements in LVEF in patients with NIDCM. In addition, ECV may be a predictive factor for HF-related hospitalization.

Relationship of Nonseptal Late Gadolinium Enhancement to Ventricular Tachyarrhythmia in Hypertrophic Cardiomyopathy.

OBJECTIVE: This study aimed to determine the relationship between the extent and the location of late gadolinium enhancement (LGE) and ventricular tachyarrhythmia or implantable cardioverter defibrillator (ICD) in hypertrophic cardiomyopathy (HCM). METHODS: We enrolled 115 patients with HCM and LGE. The location of LGE was divided into septal and nonseptal segments. Clinical backgrounds and LGE were compared in patients between with and without the arrhythmia or consequent ICD installation. RESULTS: There were significant differences in the number of risk markers, left ventricular ejection fraction, extent of global LGE, and extent of nonseptal LGE between the groups (P < 0.01). Multivariate analysis revealed that the number of risk markers and extent of nonseptal LGE contributed to ventricular tachyarrhythmia or ICD installation (P < 0.01). CONCLUSIONS: The nonseptal LGE is related to ventricular tachyarrhythmia or ICD installation. We should be vigilant for nonseptal LGE when applying LGE to risk stratification for HCM.

Myocardial T2 Mapping in Patients With Hypertrophic Cardiomyopathy.

OBJECTIVE: The aim of this study was to evaluate the usefulness of T2 mapping for detecting myocardial injuries in patients with hypertrophic cardiomyopathy (HCM). METHODS: Twenty-one HCM patients and 7 healthy volunteers were examined. The T2 values were measured at hyperintense areas (high-T2 areas) identified with T2 mapping, at late gadolinium enhancement (LGE) areas, and in nullified myocardium of the HCM patients. The associations between T2 values and laboratory data or LGE areas were assessed. RESULTS: High-T2 areas had significantly greater T2 values than LGE areas (P < 0.05) and nullified areas (P < 0.01) of HCM and normal myocardium (P < 0.01). The presence of high-T2 areas was associated with an increase in troponin T levels (P = 0.02), and T2 values correlated with the levels of brain natriuretic peptide (P = 0.036, r = 0.86). CONCLUSIONS: T2 mapping identified myocardial injuries suggested by the laboratory data in HCM.

4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics.

INTRODUCTION: Our aim was to assess the feasibility of using time-resolved 3D phase-contrast (4D flow) MRI to characterize extracranial-intracranial (EC-IC) bypass. METHODS: We enrolled 32 patients who underwent EC-IC bypass (15 men, 17 women; mean age 66.4 years). In all, 16 underwent radial artery graft (RAG) bypass and 16 underwent superficial temporal artery (STA) bypass. 4D flow MRI, time-of-flight (TOF) magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were performed. Bypass patency, flow direction, and blood flow volume (BFV) of each artery were determined by 4D flow MRI. Arterial diameters were measured by TOF-MRA and CTA. We compared RAG and STA bypasses by evaluating the flow direction and BFV of each artery. We evaluated the correlation between arterial diameters (measured by CTA or MRA) and the BFV and the detectability of flow direction (measured by 4D flow MRI) of each artery. RESULTS: 4D flow MRI confirmed the patency of each bypass artery. Flow direction of the M1 segment of the middle cerebral artery and BFV in the bypass artery differed between RAG and STA groups (p < 0.01). BFV in the bypass slightly correlated with the diameters on CTA (p < 0.05, R (2) = 0.287). Of the 29 arteries in the circle of Willis, nine were not depicted on 4D flow MRI. Cutoff values for arterial diameters on CTA and TOF-MRA for detecting the artery on 4D flow MRI were 2.4 and 1.8 mm, respectively. CONCLUSION: 4D flow MRI provided unique information for characterizing EC-IC bypasses, although this detectability is limited when addressing small arteries with slow flow.

Relationship of postcontrast myocardial T1 value and delayed enhancement to reduced cardiac function and serious arrhythmia in dilated cardiomyopathy with left ventricular ejection fraction less than 35.

BACKGROUND: Dilated cardiomyopathy (DCM) is often associated with progressive heart failure or ventricular arrhythmia. Look-Locker magnetic resonance imaging (MRI) allows quantitative evaluation of interstitial fibrosis by measuring the myocardial T1 value, and delayed enhancement (DE) MRI visualizes myocardial scar. PURPOSE: To determine the relationship of postcontrast myocardial T1 value or DE to reduced cardiac function or sustained ventricular tachycardia (SVT) in DCM patients with a left ventricular ejection fraction (LVEF) <35%. MATERIAL AND METHODS: We enrolled 41 patients with DCM. Correlations between the cardiac function parameters and postcontrast myocardial T1 value or extent of DE were evaluated. The relationship between SVT and the T1 values or extent of DE was assessed. The correlation between the extent of DE and the T1 value was also examined. RESULTS: The postcontrast myocardial T1 value was significantly correlated with the LVEF (P < 0.05; r = 0.31) and end-diastolic volume (P < 0.01; r = -0.40) in 40 patients with LVEF <35%. DE was not correlated with the cardiac function, but provided a high negative predictive value of 94.7% for SVT. No correlation was found between the myocardial T1 value and extent of DE. CONCLUSION: In DCM patients with LVEF <35%, the postcontrast myocardial T1 value correlated with the severity of cardiac dysfunction, and the absence of DE indicated the low risk of SVT. Both MRI parameters should be estimated because they may reflect discrete forms of myocardial damages in patients with DCM.

Distribution and Clinical Significance of High Signal Intensity of the Myocardium on T2-Weighted Images in 2 Phenotypes of Hypertrophic Cardiomyopathy.

OBJECTIVE: The aim of this study was to evaluate distribution and clinical significance of high signal intensity of the myocardium on T2-weighted images (T2-HI) in 2 phenotypes of hypertrophic cardiomyopathy (HCM). METHODS: Thirty-six patients with asymmetrical septal HCM (ASH) and 18 patients with apical HCM (APH) and their 864 myocardial segments were investigated. The distribution of T2-HI was compared with that of late gadolinium enhancement (LGE), and the relationships between T2-HI and clinical risk markers were evaluated. T2 values of the T2-HI were estimated with T2 mapping. RESULTS: The T2-HI was observed in 18 segments (3.1%) in 13 patients with ASH (36.1%) and in 12 segments (4.2%) in 8 patients with APH (44.4%). It was often localized outside LGE. The presence of T2-HI was related to syncope in ASH (P = 0.016). Furthermore, it had higher T2 values (61.1 milliseconds) than the reference myocardium (47.3 milliseconds). CONCLUSIONS: High signal intensity of the myocardium on T2-weighted images often locates outside LGE and reflects myocardial damage, which is related to syncope in ASH.

Magnetic resonance imaging of microvascular obstruction in hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation.

BACKGROUND: The clinical significance of microvascular obstruction (MO) in hypertrophic cardiomyopathy (HOCM) after percutaneous transluminal septal myocardial ablation (PTSMA) remains unknown. PURPOSE: To assess the relationship between the location of MO and the improvement in symptoms and pressure gradient after PTSMA in patients with HOCM. MATERIAL AND METHODS: Twenty-three patients with HOCM underwent MRI within 24 weeks after PTSMA. The MO was defined visually as the hypointense region adjacent to the left or right ventricular cavity, which was surrounded by myocardial infarction. The location of MO and improvement in clinical symptoms and pressure gradient at 3-6 months follow-up were assessed. RESULTS: MO was observed in 16 patients who underwent MRI within 7 weeks after PTSMA. Left-sided MO was observed in 12 patients, and right-sided MO was observed in four patients. Improvement in clinical symptoms and reduction in the pressure gradient were not sufficient in the patients with right-sided MO, while PTSMA was effective in the patients with the left-sided MO. CONCLUSION: The location of MO identified by MRI may be related to the effectiveness of PTSMA at the short-term follow-up. The left-sided MO is related to complete improvement in clinical symptoms and pressure gradients.

Myocardial fibrosis evaluated by Look-Locker and late gadolinium enhancement magnetic resonance imaging in apical hypertrophic cardiomyopathy: association with ventricular tachyarrhythmia and risk factors.

PURPOSE: To evaluate the distribution and extent of myocardial fibrosis identified by either contrast-enhanced Look-Locker or late gadolinium enhancement magnetic resonance imaging (LGE MRI) and their relationships between ventricular tachyarrhythmia or risk factors in apical hypertrophic cardiomyopathy (APH). MATERIALS AND METHODS: Twenty-five APH patients were examined using a 3.0 T or 1.5 T instrument. We used MRI to evaluate myocardial T1 values and scar. We compared the myocardial fibrosis assessed by contrast-enhanced Look-Locker or LGE MRI with ventricular tachyarrhythmia or risk factors for hypertrophic cardiomyopathy. RESULTS: Myocardial scar was present in 17 of the 25 patients with APH. Myocardial scar was distributed predominantly in the apical myocardium (P < 0.01), whereas myocardial T1 values did not differ between the apical, midventricular, and basal septum. The extent of myocardial scar according to 16-segment model and ejection fraction were related to ventricular tachyarrhythmia or risk factors in APH (P < 0.05 for both). The myocardial T1 value was not associated with the tachyarrhythmia or risk factors. CONCLUSION: In APH, the extent of myocardial scar on LGE MRI is associated with ventricular tachyarrhythmia and risk factors. Quantification of the myocardial T1 value is not necessary for its risk stratification.

Delayed enhancement magnetic resonance imaging in hypertrophic cardiomyopathy with Basal septal hypertrophy and preserved ejection fraction: relationship with ventricular tachyarrhythmia.

OBJECTIVE: This study aimed to determine the relationship between delayed enhancement magnetic resonance imaging (DE MRI) and ventricular tachyarrhythmia in patients with hypertrophic cardiomyopathy (HCM) with basal septal hypertrophy and preserved ejection fraction (EF). METHODS: One hundred seven patients with HCM with basal septal hypertrophy and EF greater than 50% underwent cine and DE MRI. Myocardial scar was identified with DE MRI. We assessed whether patient,s background, cine MRI findings, presence of myocardial scar, or number of scarred myocardial segments was related to the occurrence of ventricular tachyarrhythmia. RESULTS: Patient,s age, family history of HCM, and number of scarred segments differed between the patients with and without the arrhythmia. A family history of HCM and number of scarred segments were significantly related to ventricular tachyarrhythmia (P < 0.01). CONCLUSIONS: The number of scarred segments is the significant DE MRI parameter related to ventricular tachyarrhythmia in HCM with basal septal hypertrophy and preserved EF.

Next-generation sequencing of primary testicular lymphoma and relapse in the glans penis after prophylactic radiation therapy: a rare case report.

BACKGROUND: Primary testicular lymphoma (PTL) is relatively rare. The contralateral testis is a common site of PTL relapse; therefore, once complete remission is achieved, radiation therapy (RT) is administered to the contralateral testis to prevent relapse. CASE PRESENTATION: A 76-year-old man was diagnosed with PTL and received RT as described above. However, despite achieving and maintaining complete remission, a mass diagnosed as diffuse large B-cell lymphoma by tissue biopsy developed in the glans penis 6.5 years after prophylactic RT. We investigated whether the glans penile lymphoma was PTL relapse or a new malignancy by genomic analysis using next-generation sequencing of DNA extracted from two histopathological specimens. CONCLUSIONS: We found the same variant allele fraction in four somatic genes (MYD88, IL7R, BLNK, and FLT3) at similar frequencies, indicating that the glans penile lymphoma had the same origin as the PTL. To the best of our knowledge, this is the first case report of PTL relapse in the glans penis.

Comparison of perfusion-metabolism mismatch in 99mTc-MIBI and 123I-BMIPP scintigraphy with cardiac magnetic resonance in patients with dilated cardiomyopathy.

BACKGROUND: Cardiac magnetic resonance (CMR) imaging is an established method of detecting myocardial fibrosis related to prognosis in patients with dilated cardiomyopathy (DCM). Recent studies have found that (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) and (123)I-15-(p-iodophenyl)-3(R,S)-methylpentadecanoic acid (BMIPP) dual single-photon-emission computerized tomography (MIBI-BMIPP dual SPECT) can detect perfusion-metabolism mismatches. We compared MIBI-BMIPP dual SPECT with CMR findings and assessed their prognostic abilities to determine the significance of abnormal metabolism in patients with DCM. METHODS AND RESULTS: Fifty inpatients with DCM (age 58 ± 12 y; 14 female) were assessed with the use of MIBI-BMIPP dual SPECT and CMR. Perfusion-metabolism mismatches were identified mainly at the left ventricular free wall, whereas late gadolinium enhancement (LGE) was evident mostly at the septal wall. During a median follow-up of 33 months, 9 patients developed cardiac events including death, heart failure, and fatal arrhythmia. Event-free survival rates were significantly lower for patients with LGE plus a mismatch than with other abnormalities (P = .001). Among clinical and imaging variables, LGE plus a mismatch was significantly associated with cardiac events (hazard ratio 7.9, 95% confidence interval 1.8-35.6; P = .007). CONCLUSIONS: Coexisting LGE and a perfusion-metabolism mismatch accurately predict future cardiac events in patients with DCM.

Evaluation of nonscarred myocardial T1 value using contrast-enhanced look-locker cardiac MRI and its relationship to cardiac function in dilated cardiomyopathy: Comparison of 1.5 and 3.0 Tesla MRI.

PURPOSE: To assess relationship between nonscarred myocardial T1 value measured using contrast-enhanced Look-Locker MRI and cardiac function in dilated cardiomyopathy (DCM) at 1.5 Tesla (T) and 3.0T MRI. MATERIALS AND METHODS: Contrast-enhanced Look-Locker MRI was performed in 35 DCM patients. Nonscarred myocardial and blood T1 values were calculated from the signal intensity values and the delay time obtained on Look-Locker MRI. We assessed the correlation between the myocardial T1 value or myocardial T1 minus blood T1 value and cardiac function estimated using cine MRI (e.g., end-diastolic volume: EDV, left ventricular ejection fraction: LVEF) or brain natriuretic peptide (BNP). RESULTS: With 1.5T MRI (n = 16), the myocardial T1 value correlated negatively with the EDV(r = -0.66) and end-systolic volume (ESV; r = -0.68), and positively with the LVEF (r = 0.51); the myocardial T1 minus blood T1 value correlated inversely with EDV (r = -0.70), ESV (r = -0.62), and brain natriuretic peptide (BNP; r = -0.56). With 3.0T MRI (n = 17), the myocardial T1 value correlated negatively with ESV (r = -0.44), septal thickness (r = -0.60), and BNP (r = -0.51), and positively with LVEF (r = 0.61); the myocardial T1 minus blood T1 value negatively correlated with BNP (r = -0.50) and positively with LVEF (r = 0.54). CONCLUSION: The nonscarred myocardial T1 value measured with either 1.5T or 3.0T contrast-enhanced Look-Locker MRI is significantly related to cardiac dysfunction in DCM.