of the Max - MDC

Cardiovascular Magnetic
Resonance
Jeanette
Schulz-Menger
The CMR group at the Franz-Volhard-Klinik has focused its
research on the in vivo assessment of functional and structural
myocardial abnormalities related to inflammatory diseases
and coronary heart disease. Using two 1.5 clinical MRI-scanners
with dedicated cardiac software we developed new approaches
for the differentiation of tissue changes in myocardial diseases.
The application as research tools and the translation into a clinical
setting are the main interests of the group.
The successful application for Ultra-Highfield-Systems was one
of major future oriented advances within the last year and will
offer the opportunity for translational research applying advanced
imaging modalities.
Myocardial Injury
The diagnosis of myocarditis and the assessment of myocardial
tissue changes during follow-up is a challenging task in
cardiovascular research and clinical cardiology. Clinical
presentation of patients with myocarditis often mimics
other disorders and may vary from flu-like symptoms or subclinical
disease to acute heart failure and sudden cardiac
death. Cardiovascular magnetic resonance (CMR) has the
capability to differentiate between the various forms of
myocardial injuries (e.g. edema, hyperemia and fibrosis). In
the late 90s we developed an approach for the noninvasive
detection of acute myocarditis by CMR. In 2005 we published
a new multi-sequential approach with a significantly
increased diagnostic accuracy. (1) Myocardial inflammation
also has a high prognostic impact in different systemic diseases.
However early assessment is difficult. We used CMR
technology in patients with sarcoidosis and were able to
detect myocardial involvement in those patients with preserved
left-ventricular function. (2) Research in Churg
Strauss syndrome, systemic lupus erythematosus and amyloidosis
is ongoing. The current multi-sequential approach
allows the quantitative assessment of edema, as well as the
detection of reversible and irreversible contrast-enhancement
(corresponding to hyperemia, capillary leakage and
fibrosis, respectively). Further technical developments will
improve the diagnostic accuracy of diffuse homogeneous
abnormalities of the myocardium. A new pulse sequence
which allows to directly quantifying magnetic relaxation
properties of the myocardium was generated and is now
implemented. (3) The diagnostic value of this new method
will be studied in various clinical settings, with a focus on
patients with inflammatory diseases.
Coronary Artery Disease and Arteriosclerosis
The detection of coronary artery stenosis is a growing field
in CMR. We compared the performance of a contrastenhanced
to a non-contrast breath-hold 3D-SSFP-pulse
sequence and showed that extensive parts of the coronary
arteries are detectable without application of contrast
media. (4) The need to differentiate between acute from
chronic and irreversible myocardial injury, as well as to
evaluate the impact of myocardial injury is a common challenge
in clinical decision-making and often represents a
limit for currently available imaging modalities. We have
shown that combined sequences offer the capability to differentiate
acute from chronic myocardial infarction and the
impact of reperfusion injury after acute myocardial infarction.
Elective percutaneous interventions are associated
with intermittent impairment of myocardial perfusion and
its impact on prognosis and therapeutic consequences are
under investigation. Quantitative analysis of perfusion is a
crucial step for evaluation of significant ischemia and development
of new therapeutic strategies. (5) It is known that
the degree of a vessel stenosis is not a strong marker for
vulnerability. A new field in CMR is the work on the atherosclerotic
plaque differentiation. We started to assess plaque
morphology in the carotid artery. In a clinical setting we
identified MR signals suggestive for vulnerable plaques, a
finding which was independent of the degree of stenosis.
Selected Publications
Abdel-Aty, H, Boye, P, Zagrosek, A, Wassmuth, R, Kumar, A,
Messroghli D, Bock P, Dietz R, Friedrich MG and Schulz-Menger J.
Diagnostic performance of cardiovascular magnetic resonance in
patients with suspected acute myocarditis: comparison of different
approaches. J Am Coll Cardiol 2005;45(11):1815-22.
Schulz-Menger, J, Wassmuth, R, Abdel-Aty, H, Franke, A, Dietz,
R and Friedrich, M. Patterns of Myocardial Inflammation and
Scarring in Sarcoidosis as Assessed by Cardiovascular Magnetic
Resonance, HEART Heart. 2006,92(3), 399-400.
Messroghli, DR, Greiser, A, Fröhlich M, Dietz, R and Schulz-
Menger, J. Optimization and Validation of a Fully Integrated
Pulse Sequence for Modified Look-Locker Inversion Recovery
(MOLLI) T1 Mapping of the Heart, JMRI 2007 in press.
34 Cardiovascular and Metabolic Disease Research