Noncardiac Pathology on Clinical Cardiac Magnetic Resonance Imaging
Peter G. Chan, MD*,*,
Martin P. Smith, MD ,
Thomas H. Hauser, MD*,
Susan B. Yeon, MD*,
Evan Appelbaum, MD*,
Neil M. Rofsky, MD,
Warren J. Manning, MD*,
* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Figure 1 Distribution of Major Noncardiac Pathology
Pie chart distribution of the individual major noncardiac pathologies identified on cardiac magnetic resonance scanning. These findings were noted in 48 distinct reports for an overall prevalence of 3.1%. Lymphadenopathy and lung abnormalities were the most common. Data are presented with the number of major noncardiac findings, with the pie chart demonstrating the percent of total major noncardiac findings.
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Figure 2 Example of Major Noncardiac Pathology
An example of major noncardiac pathology. Axial T2-weighted fast-spin echo fat-suppressed cardiac magnetic resonance images in a patient with previously unrecognized Hodgkin's lymphoma. Note the marked and diffuse increase in mediastinal lymphadenopathy (white areas within yellow circles), which represent prominent lymph nodes. Subsequent biopsy confirmed Hodgkin's lymphoma.
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Figure 3 Example of Major Noncardiac Pathology
(A) Balanced cine steady-state free precession cardiac magnetic resonance (CMR) in the double oblique 4-chamber orientation and (B) axial T2-weighted fast spin echo axial image with fat saturation (no exogenous contrast). A lung mass (bright white mass within the yellow circle) on the T2-weighted fast spin echo axial image is readily apparent. Although present, the abnormality is more subtle on the balanced steady-state free precession image. This highlights the potential of noncardiac pathology to be masked using some of the common CMR sequences. Subsequent evaluation determined this to be a pulmonary carcinoid tumor.
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Figure 4 Example of Major Noncardiac Pathology
(A) Axial T2-weighted fast spin-echo image, (B) balanced cine steady-state free precession cardiac magnetic resonance (CMR) in the double-oblique short axis orientation, and (C) large gadolinium enhancement (fibrosis imaging 15 min after administration of 0.2 mmol/kg of gadolinium) CMR in the same short axis orientation as (B). Note the lesion in the breast which is "dark" on fast spin echo and steady-state free precession and then "bright" after gadolinium contrast. Subsequent biopsy demonstrated a breast fibroadenoma.
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Figure 5 Example of Major Noncardiac Pathology
Series of 4 axial T2-weighted fast spin-echo images of the thorax. Note the patchy and diffuse intermediate signal intensity within the right lung field. More opacities are seen on the right, and not all opacities are dependent (as would be expected with atelectasis). The appearance is suggestive of multifocal pneumonia. Subsequent biopsy demonstrated cryptogenic organizing pneumonia.
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Figure 6 Distribution of Minor Noncardiac Pathology
A pie chart distribution of the individual minor noncardiac pathologies identified on cardiac magnetic resonance scanning. These findings were noted in 70 distinct reports for an overall prevalence of 4.6%. Pleural effusions and benign liver and renal cysts were the most common. Data are presented with the number of minor noncardiac findings with the pie chart demonstrating the percent of total minor noncardiac findings.
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Figure 7 Example of Minor Noncardiac Pathology
Double oblique cardiac magnetic resonance (CMR) imaging using (A) cine steady-state free precession and (B) late gadolinium enhancement CMR imaging in the same orientation. The abnormality (yellow circle) is "bright" in the cine steady state free precession sequence (A), suggesting a cystic (or vascular) structure. The dark appearance on late gadolinium enhancement CMR is consistent with a cyst (B).
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