Bernd Christian Cornelius MD, Presenter: Nothing to Disclose

Andreas Kilkowski MD, Abstract Co-Author: Nothing to Disclose

Thomas Scheidt, Abstract Co-Author: Nothing to Disclose

Bernd Mark MD, Abstract Co-Author: Nothing to Disclose

Daryusch Vossoughi MD, Abstract Co-Author: Nothing to Disclose

Guenter Layer MD, Abstract Co-Author: Nothing to Disclose

Tako-Tsubo Cardiomyopathy (TTC), first described in Japanese patients (pat), is a rare disease characterized by transient left ventricular apical ballooning (BA) and hyperkinetic basal segments. Pat have ST-elevations and increased Troponin (TNT) but no coronary artery disease (CAD) or myocarditis. In TTC early noninvasive diagnosis is desirable because of its good prognosis. Not much is known about the value of MRI in TTC. The purpose of our study was to evaluate white blood cine, T2w fat suppressed (TIRM), early (MVO) and late enhancement (LE) sequences to characterize TTC in comparison to myocarditis.

Cardiac MRI (MRI) was performed in 74 pat (59 +/- 16 y, 43% male) with ST-elevation and increased TNT but no significant CAD. The MRI was performed with a 1,5 Tesla MR scanner (Magnetom Sonata, Siemens). The protocol included ECG triggered standard cine sequences plus T2w TIRM or T2w TSE fat suppressed and contrast enhanced T1w GRE sequences directly (MVO) and 10-15 minutes after injection of 0.1mmol/kg/BW Gd-DPTA (LE).

In 43 pat typically changes due to myocarditis (patchy LE and edema), in 3 due to CAD (subendocardial LE) were found. Nine pat had no pathological findings, in 12 pat quality of MRI was bad. 7 female pat presented findings highly suspected for TTC: 7/7 typical BA, 4/7 LE (discrete, diffuse and laminar but not patchy or subendocardial), 3/7 plus correlating increased signal in TIRM. MVO was not found in TTC.

Apart from the typical BA, TTC was characterized in 4 pat with additional pathological findings: diffuse and laminar LE, edema and but lack of MVO which were seen regularly in CAD and sometimes in myocarditis. The changes in TTC are different to CAD and myocarditis. In our study group MRI shows typical changes for TTC and therefore may spare the pat a PCA.

MRI is able to differentiate TTC from other cardiomyopathies by typical changes and therefore can the pat spare further diagnostics.

Cornelius, B, Kilkowski, A, Scheidt, T, Mark, B, Vossoughi, D, Layer, G, Tako-Tsubo Cardiomyopathy: Cardiac MRI Characteristics Using TIRM—Early and Late Enhancement.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4429494.html