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MRI of Cardiac Sarcoidosis: Basal and Subepicardial Localization of Myocardial Lesions and Their Effect on Left Ventricular Function

¹ Department of Radiology, Tohoku University Graduate School of Medicine, Seiryomachi, Aobaku, Sendai 980-8574, Japan.
² Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —29-segment model of left ventricle. Diagrams illustrate basal and mid short-axis slices (A), apical short-axis slice (B), and horizontal long-axis slice (C). In diagrams that correspond to basal slices 1 and 2 (A) and mid slices 3 and 4 (C), left ventricular (LV) myocardium is divided into six segments including anterior, lateral, inferior, and septal walls, whereas it is divided into four segments in slice 5 of diagram (B), which corresponds to apical slice 5 in diagram (C). LV myocardium at extreme tip of ventricle apex (gray shading, C), where there is no longer cavity, is defined as another segment, apex. RV= right ventricle.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —29-segment model of left ventricle. Diagrams illustrate basal and mid short-axis slices (A), apical short-axis slice (B), and horizontal long-axis slice (C). In diagrams that correspond to basal slices 1 and 2 (A) and mid slices 3 and 4 (C), left ventricular (LV) myocardium is divided into six segments including anterior, lateral, inferior, and septal walls, whereas it is divided into four segments in slice 5 of diagram (B), which corresponds to apical slice 5 in diagram (C). LV myocardium at extreme tip of ventricle apex (gray shading, C), where there is no longer cavity, is defined as another segment, apex. RV= right ventricle.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —29-segment model of left ventricle. Diagrams illustrate basal and mid short-axis slices (A), apical short-axis slice (B), and horizontal long-axis slice (C). In diagrams that correspond to basal slices 1 and 2 (A) and mid slices 3 and 4 (C), left ventricular (LV) myocardium is divided into six segments including anterior, lateral, inferior, and septal walls, whereas it is divided into four segments in slice 5 of diagram (B), which corresponds to apical slice 5 in diagram (C). LV myocardium at extreme tip of ventricle apex (gray shading, C), where there is no longer cavity, is defined as another segment, apex. RV= right ventricle.

View larger version (43K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —27-year-old man with cardiac sarcoidosis and intact coronary arteries on coronary angiography (patient 1). Delayed contrast-enhanced MR images (A–C) and corresponding (by slice) cine MR images (D–F). Delayed contrast-enhanced MR images show apparent hyperenhancement that primarily involves basal side at interventricular septum, inferior wall, and lateral wall (arrowheads, A) and extends to inferior to lateral portions of mid slices and apical slices (arrows, B and C). Hyperenhancement is predominantly present in epicardial layer of myocardium. Wall with hyperenhancement does not show thinning and is of normal thickness on cine MR images.

View larger version (41K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —76-year-old woman with cardiac sarcoidosis and intact coronary arteries on coronary angiography (patient 6). Delayed contrast-enhanced MR images (A–D) and corresponding (by slice) cine MR images (E–H). Basal mid anterior wall with hyperenhancement shows decreased thickness of myocardium (arrowheads, E and F) on cine MR images. Arrows = hyperenhancement of myocardium.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Localization of myocardial hyperenhancement, which was scored as follows: 0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement. Horizontal lines ("whiskers") above each bar show standard error. ANOVA = analysis of variance. Bar graph shows average hyperenhancement score for short axis slices. For slice 1, p < 0.05 versus slice 4 and p < 0.005 versus slice 5; for slice 2, p < 0.05 versus slice 5.

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Localization of myocardial hyperenhancement, which was scored as follows: 0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement. Horizontal lines ("whiskers") above each bar show standard error. ANOVA = analysis of variance. Bar graph shows average hyperenhancement score for each myocardial wall.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Localization of myocardial hyperenhancement, which was scored as follows: 0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement. Horizontal lines ("whiskers") above each bar show standard error. ANOVA = analysis of variance. Bar graph shows average number of hyperenhanced segments in subepicardial, midmyocardial, and subendocardial layers per patient. For subepicardial layer, p < 0.05 versus subendocardial layer.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Bar graphs show relationship of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) to characteristics of myocardial wall. Horizontal lines ("whiskers") above each bar show standard error. Relationship of hyperenhancement score to regional myocardial wall thickening (A), wall motion (B), and wall thickness (C). Single asterisk indicates p < 0.0001 versus score of 4, double asterisk indicates p < 0.005 versus score of 4.

View larger version (15K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Bar graphs show relationship of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) to characteristics of myocardial wall. Horizontal lines ("whiskers") above each bar show standard error. Relationship of hyperenhancement score to regional myocardial wall thickening (A), wall motion (B), and wall thickness (C). Single asterisk indicates p < 0.0001 versus score of 4, double asterisk indicates p < 0.005 versus score of 4.

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —Bar graphs show relationship of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) to characteristics of myocardial wall. Horizontal lines ("whiskers") above each bar show standard error. Relationship of hyperenhancement score to regional myocardial wall thickening (A), wall motion (B), and wall thickness (C). Single asterisk indicates p < 0.0001 versus score of 4, double asterisk indicates p < 0.005 versus score of 4.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Graphs show correlation between sum of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) and other indicators of cardiac function. Correlation between sum of hyperenhancement score and plasma concentration of brain natriuretic peptide (BNP) (A), left ventricular ejection fraction (LVEF) (B), and left ventricular end-diastolic volume (LVEDV) index (C).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Graphs show correlation between sum of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) and other indicators of cardiac function. Correlation between sum of hyperenhancement score and plasma concentration of brain natriuretic peptide (BNP) (A), left ventricular ejection fraction (LVEF) (B), and left ventricular end-diastolic volume (LVEDV) index (C).

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Graphs show correlation between sum of hyperenhancement score (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, and 4 = 76–100% hyperenhancement) and other indicators of cardiac function. Correlation between sum of hyperenhancement score and plasma concentration of brain natriuretic peptide (BNP) (A), left ventricular ejection fraction (LVEF) (B), and left ventricular end-diastolic volume (LVEDV) index (C).

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