Produção Nacional
Revisado por pares
Cardiac Sarcoidosis Evaluated by Delayed-Enhanced Magnetic Resonance Imaging
2003; Lippincott Williams & Wilkins; Volume: 107; Issue: 20 Linguagem: Inglês
10.1161/01.cir.0000062400.74155.e6
ISSN1524-4539
AutoresJoaquín J. Serra, Guilherme Urpia Monte, Evandro Sobroza de Mello, Gabriela Perdomo Coral, Luíz Francisco Rodrigues de Ávila, José R. Parga, José Antônio Franchini Ramires, Carlos Eduardo Rochitte,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 107, No. 20Cardiac Sarcoidosis Evaluated by Delayed-Enhanced Magnetic Resonance Imaging Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBCardiac Sarcoidosis Evaluated by Delayed-Enhanced Magnetic Resonance Imaging Joaquín J. Serra, MD, Guilherme U. Monte, MD, Evandro S. Mello, MD, Gabriela P. Coral, MD, Luiz F.R. Ávila, MD, José R. Parga, MD, José A.F. Ramires, MD and Carlos E. Rochitte, MD Joaquín J. SerraJoaquín J. Serra From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , Guilherme U. MonteGuilherme U. Monte From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , Evandro S. MelloEvandro S. Mello From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , Gabriela P. CoralGabriela P. Coral From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , Luiz F.R. ÁvilaLuiz F.R. Ávila From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , José R. PargaJosé R. Parga From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. , José A.F. RamiresJosé A.F. Ramires From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. and Carlos E. RochitteCarlos E. Rochitte From the Cardiovascular Magnetic Resonance Laboratory, Heart Institute, InCor (J.J.S., G.U.M., L.F.R.A., J.R.P., J.A.F.R., C.E.R.), and Division of Pathology (E.S.M., G.P.C.), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Originally published27 May 2003https://doi.org/10.1161/01.CIR.0000062400.74155.E6Circulation. 2003;107:e188–e189A 56-year-old woman with a history of chronic coughing and occasional wheezing was referred to the gastroenterology clinic with jaundice and weight loss of recent onset. Clinical evaluation showed evidence of chronic liver disease. Chest computed tomography showed an interstitial bilateral lung infiltrate and diaphragmatic lymphadenopathy. A liver biopsy was performed, revealing a noncaseating granulomatous hepatitis (Figure 1). Thorough investigation of granulomatous diseases was performed and the final diagnosis was sarcoidosis. A resting ECG showed premature atrial and ventricular beats and conduction disturbances (right bundle branch block and left anterior fascicular block). The patient was then referred to the Heart Institute (InCor) for cardiac evaluation. Download figureDownload PowerPointFigure 1. Liver biopsy showing numerous small and well-defined noncaseating epithelioid granulomas (one of them is indicated by a black arrowhead). The granulomas contain multinucleated giant cells and asteroid bodies (a typical finding of sarcoidosis) and are surrounded by portal and periportal fibrosis. No necrosis was detected (hematoxylin and eosin, 100×). Inset displays a large asteroid body (HE, 400×).A cine magnetic resonance image (MRI) showed 2 small ventricular aneurysms involving the septum and right ventricular free wall (Figure 2 and Movie I). The left ventricular ejection fraction and end-diastolic and end-systolic volumes were 0.45, 146 mL, and 84 mL, respectively. Contrast (gadolinium; dose 0.2 mmol/kg) delayed-enhanced MR images, using an inversion recovery prepped gradient-echo sequence, revealed areas of hyperenhancement (fibrosis) corresponding precisely to that of the ventricular aneurysms (Figures 2, 3, and 4; Movies I and II). Additionally, several small and focal areas of myocardial fibrosis were observed in other segments (basal antero-septal and antero-lateral; see Figure 3). Download figureDownload PowerPointFigure 2. The left and middle panels represent the end diastolic and systolic frames of a 4-chamber view cine MRI showing 2 areas of dyskinesia on interventricular septal wall and right ventricular anterior wall, characterizing 2 focal ventricular aneurysms (arrows). See the corresponding Movie I. The right panel displays the delayed-enhanced MRI with increased signal intensity within the myocardium, demonstrating fibrosis precisely on the location of aneurysms (arrows).Download figureDownload PowerPointFigure 3. Delayed-enhanced MR images of left ventricle short-axis views from apex to base demonstrate myocardial hyperenhancement at several locations. A, B, and C display hyperenhancement in the left ventricle and inferior and septal walls (arrows), corresponding to the aneurysm. D depicts myocardial hyperenhancement in the left ventricle and antero-septal and antero-lateral segments (focal fibrosis, arrows) and in the right ventricle anterior wall (arrowheads), corresponding to the right ventricular aneurysm seen in Figure 2.Download figureDownload PowerPointFigure 4. The left and middle panels represent the end-diastolic and systolic frames of a 2-chamber view cine MRI showing an area of dyskinesia in the left ventricular inferior wall (see Movie II) that corresponds to the increased signal intensity in the delayed-enhanced MRI (right panel).This new MR technique has been shown to detect irreversible myocardial injury (necrosis or fibrosis) with great detail and high spatial resolution and has been used to detect new or previous myocardial infarction.Movies I and II are available as an online-only Data Supplement at http://www.circulationaha.org.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Carlos E. Rochitte, MD, Instituto do Coração, InCor, HCFMUSP, Setor de Ressonância Magnética, Av. Dr. Enéas de Carvalho Aguiar, 44, andar AB, Cerqueira César, São Paulo-SP, Brazil 05403-000. 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Dembo L, Shifrin R and Wolff S (2004) MR imaging in ischemic heart disease, Radiologic Clinics of North America, 10.1016/j.rcl.2004.03.007, 42:3, (651-673), Online publication date: 1-May-2004. May 27, 2003Vol 107, Issue 20 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000062400.74155.E6PMID: 12777322 Originally publishedMay 27, 2003 PDF download Advertisement
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