Cardiac diffusion-weighted magnetic resonance imaging for assessment of cardiac metastasis

Cardiac diffusion-weighted magnetic resonance imaging for assessment of cardiac metastasis Incremental role of CCTA in elderly persons 683 23. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR et al. Coronary cal- Framingham Risk Score: the CARDIA study. JACC Cardiovasc Imaging cium as a predictor of coronary events in four racial or ethnic groups. NEnglJ . 2012;5:923–30. Med 2008;358:1336–45. 26. Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional conse- 24. Okwuosa TM, Greenland P, Ning H, Liu K, Bild DE, Burke GL et al. Distribution quences, and potential therapeutics for cellular senescence. Circ Res 2012;111: of coronary artery calcium scores by Framingham 10-year risk strata in the 245–59. MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary . 27. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’agostino RB, Gibbons R risk assessment. J Am Coll Cardiol 2011;57:1838–45. et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a re- 25. Okwuosa TM, Greenland P, Ning H, Liu K, Lloyd-Jones DM. Yield of screening port of the American College of Cardiology/American Heart Association Task for coronary artery calcium in early middle-age adults based on the 10-year Force on Practice Guidelines. Circulation 2014;129:S49–73. IMAGE FOCUS doi:10.1093/ehjci/jey039 Online publish-ahead-of-print 2 March 2018 .................................................................................................................................................... Cardiac diffusion-weighted magnetic resonance imaging for assessment of cardiac metastasis 1 2 3 3 1 Seitaro Oda *, Kosuke Morita ,Tomoyuki Okuaki , Tetsuo Ogino , and Yasuyuki Yamashita 1 2 Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan; Department of Central Radiology, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan; and MR Clinical Science, Kohnan 2-13-37, Minato-ku, Tokyo, 108-8507, Japan * Corresponding author. Tel: 181-96-373-5261; Fax: 181-96-362-4330. E-mail: seisei0430@nifty.com Cardiac magnetic resonance imaging (CMR) has become an increasingly utilized modality for assessing cardiac masses. However, evaluation of cardiac metastasis by CMR remains a diagnostic challenge. A 62-year-old man was admitted to our hospital because of oesophageal cancer. The patient underwent positron emission tomography/ computed tomography for staging purposes, which showed increased uptake in the primary oesophageal tumour, mediastinal lymph nodes, and left ventricular apical myocardium (Panel A). However, the myocardial uptake was difficult to differentiate from normal myocardial up- take owing to the physiological variations in myocardial metabolic activity. CMR was performed to assess the myocardial lesion. A lesion was not readily visible on cine images (Panel B), and late gadolinium-enhanced imaging showed subtle focal enhancement of Panel C. Electrocardiogram-gated cardiac diffusion-weighted imaging with acceleration compensation techniques clearly visualized focal abnormal signal intensity in the left ventricular apical myocardium (Panel D). The apparent diffusion coefficient map demonstrated a low value in the lesion (Panel E), suggesting that the mass contained high cellularity with restricted water diffusion compatible with malignant neoplasm. The patient was finally diagnosed with cardiac metastasis of oesophageal cancer. To the best of our knowledge, this report is the first to demonstrate that cardiac diffusion-weighted imaging can provide better detection, visualization, and tissue characterization in the assessment of cardiac metastasis. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/683/4917835 by Ed 'DeepDyve' Gillespie user on 20 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Cardiac diffusion-weighted magnetic resonance imaging for assessment of cardiac metastasis

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey039
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Abstract

Incremental role of CCTA in elderly persons 683 23. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR et al. Coronary cal- Framingham Risk Score: the CARDIA study. JACC Cardiovasc Imaging cium as a predictor of coronary events in four racial or ethnic groups. NEnglJ . 2012;5:923–30. Med 2008;358:1336–45. 26. Wang JC, Bennett M. Aging and atherosclerosis: mechanisms, functional conse- 24. Okwuosa TM, Greenland P, Ning H, Liu K, Bild DE, Burke GL et al. Distribution quences, and potential therapeutics for cellular senescence. Circ Res 2012;111: of coronary artery calcium scores by Framingham 10-year risk strata in the 245–59. MESA (Multi-Ethnic Study of Atherosclerosis) potential implications for coronary . 27. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’agostino RB, Gibbons R risk assessment. J Am Coll Cardiol 2011;57:1838–45. et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a re- 25. Okwuosa TM, Greenland P, Ning H, Liu K, Lloyd-Jones DM. Yield of screening port of the American College of Cardiology/American Heart Association Task for coronary artery calcium in early middle-age adults based on the 10-year Force on Practice Guidelines. Circulation 2014;129:S49–73. IMAGE FOCUS doi:10.1093/ehjci/jey039 Online publish-ahead-of-print 2 March 2018 .................................................................................................................................................... Cardiac diffusion-weighted magnetic resonance imaging for assessment of cardiac metastasis 1 2 3 3 1 Seitaro Oda *, Kosuke Morita ,Tomoyuki Okuaki , Tetsuo Ogino , and Yasuyuki Yamashita 1 2 Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan; Department of Central Radiology, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-8556, Japan; and MR Clinical Science, Kohnan 2-13-37, Minato-ku, Tokyo, 108-8507, Japan * Corresponding author. Tel: 181-96-373-5261; Fax: 181-96-362-4330. E-mail: seisei0430@nifty.com Cardiac magnetic resonance imaging (CMR) has become an increasingly utilized modality for assessing cardiac masses. However, evaluation of cardiac metastasis by CMR remains a diagnostic challenge. A 62-year-old man was admitted to our hospital because of oesophageal cancer. The patient underwent positron emission tomography/ computed tomography for staging purposes, which showed increased uptake in the primary oesophageal tumour, mediastinal lymph nodes, and left ventricular apical myocardium (Panel A). However, the myocardial uptake was difficult to differentiate from normal myocardial up- take owing to the physiological variations in myocardial metabolic activity. CMR was performed to assess the myocardial lesion. A lesion was not readily visible on cine images (Panel B), and late gadolinium-enhanced imaging showed subtle focal enhancement of Panel C. Electrocardiogram-gated cardiac diffusion-weighted imaging with acceleration compensation techniques clearly visualized focal abnormal signal intensity in the left ventricular apical myocardium (Panel D). The apparent diffusion coefficient map demonstrated a low value in the lesion (Panel E), suggesting that the mass contained high cellularity with restricted water diffusion compatible with malignant neoplasm. The patient was finally diagnosed with cardiac metastasis of oesophageal cancer. To the best of our knowledge, this report is the first to demonstrate that cardiac diffusion-weighted imaging can provide better detection, visualization, and tissue characterization in the assessment of cardiac metastasis. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/683/4917835 by Ed 'DeepDyve' Gillespie user on 20 June 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 2, 2018

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