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: dr s venkatesan 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
More News: Amyloidosis | Anatomy | Angiography | Cardiology | Heart | Hypertrophic Obstructive Cardiomyopathy | Myopia (short sighted) | Perfusion