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Cardiac MR of extensive myocardial ischemia

Case Study
Gebker, Rolf, M.D., Ph.D. German Heart Institute Berlin • Germany

Extensive myocardial ischemia in patient with multi-vessel coronary artery disease

Patient history

65-year-old male with suspected coronary artery disease, atypical angina, hyperlipidemia and arterial hypertension. Bicycle ergometry was inconclusive since the patient did not reach target heart rate due to physical deconditioning.

MR examination

Ingenia 3.0T with Anterior and integrated Posterior coils was used for a typical vasodilator stress CMR. Two IV lines were applied for adenosine and contrast agent. Continuous monitoring of blood pressure and VCG throughout vasodilator stress.

Dynamic (perfusion) images with voxel size of 2.5 x 2.5 x 8 mm.
 
Breath hold was about 15 seconds during the first pass of the contrast agent through the left ventricle and myocardium.

The ExamCard adenosine stress perfusion can be found in:

Ingenia 3.0T Cardiac ExamCards according to the SCMR guidelines.

 

First pass dynamic perfusion
First pass dynamic perfusion
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The three short axis views during first pass of a contrast agent during vasodilator stress show multiple darker areas in both the anteroseptal and inferolateral wall (white arrows) representing deficits in myocardial perfusion.

Invasive coronary angiography demonstrated an occlusion of both the LAD and LCX (arrows).
Invasive coronary angiography demonstrated an occlusion of both the LAD and LCX (arrows).

Diagnosis

Extensive myocardial ischemia in the anteroseptal and inferolateral wall.

Impact of Ingenia 3.0T on cardiac MR imaging

Vasodilator stress CMR allows the correct depiction of regional ischemia. The ability of an imaging method to identify a patient as having multi-vessel disease has important implications regarding further patient management and prognosis.


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Dec 12, 2012

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Case Study
Ingenia 3.0T
Release 4
Cardiac, cmr, Function Cine, Myocardial Ischemia
 

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