How to diagnose DCM with confidence by myocardial scar photography ?

While many of us are preoccupied with wires and balloons ,( coronary  myopia ! )  , our radiology  colleagues are making rapid strides . Let us spend some  time  to understand  how  the myocardial segments  are inflicted the  final insult . We need to realize , there is a pattern  to  this myocardial  end game of scarring and fibrosis. MRI is the  gold standard to assess the myocardial architecture . It has a role in both assessing the anatomy , function  , perfusion and viability . LV function is assessed  by cine MRI Viability  stud by  delayed enhancement MRI (DEMRI , also called as  LGE- Late Gadolinum enhancement  ) Myocardial scar best assessed by DEMRI* * Why do you require DEMRI to identify scar ? One can detect scars in plain MRI but contrasts make it better .Hence delayed enhancement in by DEMRI is used  to detect scars. Is it ischemic  DCM or Non ischemic DCM ?  ( That is the question we commonly ask   We rely too much on CAG anatomy for this. It can be misleading. Cine MRI with DEMRI  gives the answer straightway with high degree of accuracy  .  CAG is required in all  ,  but if it is normal , or  has insignificant lesions  , the dilemma  of ischemic DCM would continue !) **Note ,there is one   simple algorithm proposed by the author   to  differentiate  Ischemic DCM from Idiopathic DCM  without MRI – Click here to  Link Following  scar patterns in DEMRI help us to arrive a diagnosis. Favors Non ischemic  ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiac MRI Cardiology -unresolved questions myocardial disease demri epicardial scars how to differentiate ischemic from non ischemic dcm late gadolinium enhancement lge gadolinium mid myocardial scar myocardial scar Imaging scar loca Source Type: blogs