Kai Nassenstein, Presenter: Nothing to Disclose

Frank Breuckmann, Abstract Co-Author: Nothing to Disclose

Peter Hunold MD, Abstract Co-Author: Speaker, Bayer AG Speaker, General Electric Company Speaker, Guerbet Speaker, Siemens AG

Alexander Kreuter MD, Abstract Co-Author: Nothing to Disclose

Joerg Barkhausen MD, Abstract Co-Author: Research Consultant, Bayer AG

Progressive systemic sclerosis (SSc) represents a complex disorder of obscure etiology which affects the skin as well as various organs. Cardiac manifestations of SSc may result in pericardial or vavular diseases, conduction system abnormalities and arrhythmias; however myocardial fibrosis is the hallmark with major impact on patients’ prognosis. Our study aimed to assess cardiac MRI for the detection of cardiac involvement in SSc.

MRI was performed in 34 patients (30 female, 4 male; age, 54 ± 14 yrs) with known SSc on a 1.5 T MR system. The scan protocol included a cine steady-state free precession sequences (TrueFISP, TR 3 ms, TE 1.5 ms, FA 60°) in long and short axis views to assess myocardial and valvular function and T2-weighted fat-suppressed turbo spin echo images (TR 2 heart beats, TE 49ms, FA 180°) in identical slice positions to visualize myocardial edema. Inversion-recovery fast low angle shot sequences (TurboFLASH, TR 8.0ms, TE 4.0ms, TI 180-240ms, FA 20°) were applied 15 minutes after injection of 0.2 mmol Gd-DTPA/ kg body weight to detect late enhancement (LE).

MRI detected cardiac abnormalities in 50% of our patients. A reduced ejection fraction (<55%) was observed in 29% (10 of 34). 6 of 34 patients (18%) showed a pericardial effusion. Mitral valve prolaps was observed in 9, low grade aortic valve insufficiency in 3, and tricuspidal valve insufficiency in 1 patient. No patient showed a myocardial edema on T2-weighted images. 5 patients (15 %) showed either diffuse or spotted, well defined LE as correlate of myocardial fibrosis.

Our results demonstrate the feasibility of cardiac MRI to detect cardiac involvement in SSc patients. The visualization of myocardial fibrosis, a histological hallmark of scleroderma heart disease, in-vivo is a unique feature of contrast-enhanced MR.

Cardiac MRI is feasible to detect cardiac involvement in SSC, which has a major impact on patients` prognosis. It visualizes myocardial fibrosis, the hallmark of scleroderma heart disease.

Nassenstein, K, Breuckmann, F, Hunold, P, Kreuter, A, Barkhausen, J, Systemic Sclerosis: Detection of Myocardial Fibrosis by Contrast-enhanced Magnetic Resonance Imaging.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008481.html