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Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ.

Quarta G, Holdright DR, Plant GT, Harkness A, Hausenloy D, Hyare H, Moon JC - J Cardiovasc Magn Reson (2011)

Bottom Line: Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI).Cardiac and brain MRI were requested to guide immunosupression.Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum.

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Affiliation: Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, London, UK.

ABSTRACT
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.

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Cardiac MRI with T2-weighted STIR images (left panel) showing oedema (arrow) and (middle and right panels) extensive patchy late gadolinium enhancement typical of sarcoid.
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Figure 4: Cardiac MRI with T2-weighted STIR images (left panel) showing oedema (arrow) and (middle and right panels) extensive patchy late gadolinium enhancement typical of sarcoid.

Mentions: Brain MRI showed susceptibility artefact associated with the shunt (Figure 2), but otherwise stable intracranial disease with scattered white matter lesions and persistent dural enhancement. Cardiac MRI showed normal LV size and systolic function with no regional wall motion abnormalities. Metallic lead artefact was minimised by switching standard SSFP cine sequence (Figure 3 and additional file 1) to spoiled gradient echo - but was not considered necessary. T2-weighted images showed basal antero-septal oedema and there was extensive sub-epicardial, sometimes transmural, basal late gadolinium enhancement (Figure 4). Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema suggesting active disease.


Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ.

Quarta G, Holdright DR, Plant GT, Harkness A, Hausenloy D, Hyare H, Moon JC - J Cardiovasc Magn Reson (2011)

Cardiac MRI with T2-weighted STIR images (left panel) showing oedema (arrow) and (middle and right panels) extensive patchy late gadolinium enhancement typical of sarcoid.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108926&req=5

Figure 4: Cardiac MRI with T2-weighted STIR images (left panel) showing oedema (arrow) and (middle and right panels) extensive patchy late gadolinium enhancement typical of sarcoid.
Mentions: Brain MRI showed susceptibility artefact associated with the shunt (Figure 2), but otherwise stable intracranial disease with scattered white matter lesions and persistent dural enhancement. Cardiac MRI showed normal LV size and systolic function with no regional wall motion abnormalities. Metallic lead artefact was minimised by switching standard SSFP cine sequence (Figure 3 and additional file 1) to spoiled gradient echo - but was not considered necessary. T2-weighted images showed basal antero-septal oedema and there was extensive sub-epicardial, sometimes transmural, basal late gadolinium enhancement (Figure 4). Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema suggesting active disease.

Bottom Line: Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI).Cardiac and brain MRI were requested to guide immunosupression.Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, London, UK.

ABSTRACT
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.

Show MeSH
Related in: MedlinePlus