Pamela K' Woodard, M'D'

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• Pamela K. Woodard, M.D.
• Mallinckrodt Institute of Radiology, St. Louis, MO

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Disclosures

• Discussion/presentation of pharmaceutical (MR
  contrast agents) classified by the FDA as
  investigational for the intended use.
• Research relationships with Siemens Medical
  Systems and TycoHealthcare/ Mallinckrodt,
  consultant Berlex Laboratories, speakers bureau
  GE Healthcare.

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Handout

• Handout available at URL address
• www.CVIL.wustl.edu

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History 17-year-old with chest pain and flu-like
symptoms two weeks ago. Troponin I was elevated
to 9 ng/ml. Cardiac catheterization revealed
normal coronary artery course.
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Question 1

• On delayed contrast-enhanced cardiac MRI, a
  patient with viral myocarditis will usually show
  enhancement in which region?
• A. Subendocardial
• B. Subepicardial
• C. Transmural
• D. Does not enhance

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Subepicardial enhancement
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Follow-up MR examination 6 weeks later
Resolution of chest pain. Resolution R cervical
LAD Labs EBV (), () mononucleosis
Diagnosis Epstein Barr myocarditis
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38 year old woman with chest pain
Transmural enhancement pattern
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Question 2

• Which portion of the myocardium is the most
  susceptible to ischemia and infarction?
• A. Subendocardial
• B. Subepicardial
• C. Transmural septum
• D. Valve leaflets

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Subendocardial Infarction
Coronary flow reserve lower in subendocardium
than subepicardium.
Yada, et al. Circulation, 1995
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Enhancement patterns
subepicardial
transmural
subendocardial
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History 33-year-old woman with pulmonary sarcoid
and new onset of arrhythmias.
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Cardiac sarcoid patchy enhancement inferior and
septal walls.
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Sarcoid restrictive cardiomyopathy
Poustchi-Amin, et al. Magn Reson Imaging Clin N
Am, 2003
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Question 3

• Sarcoid can affect which of the following?
• A. Myocardium
• B. Pericardium
• C. Mitral valve
• D. All of the above

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Sarcoid constrictive pericarditis
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Question 4

• Clinically constrictive pericarditis can have
  signs and symptoms most similar to
• A. right ventricular dysplasia.
• B. restrictive cardiomyopathy.
• C. congestive heart failure.
• D. Ebsteins anomaly.

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54-year-old man with gradual onset of lower
extremity edema.
Pericardium
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Large IVC
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