A case report in cardiovascular magnetic resonance: the contrast agent matters in amyloid
A case report in cardiovascular magnetic resonance: the contrast agent matters in amyloid
复制标题
心血管磁共振病例报告：造影剂对淀粉样蛋白很重要
作者：
M. Fontana;T. Treibel;A. Martinez;S. Rosmini;R. Kwong;J. Gillmore;P. Hawkins;J. Moon
心脏淀粉样变性是一种进行性的心力衰竭的病因，但诊断和认识不足。在过去的几年里，心血管磁共振(CMR)已经成为心脏淀粉样变性无创性诊断的黄金标准，具有心内膜下晚期Gd增强的特征。案例介绍我们描述了一例患者，在不同中心之间的试验方案对齐过程中，进行了两种不同造影剂Dotarem®和MultiHance®的配对研究。令人惊讶的是，MultiHance®未能显示出特有的成像模式，仅显示右室下部插入点的非特异性晚期Gd增强，且心肌细胞外体积分数与Dotarem®不同。MultiHance®被许多中心使用，因为它的部分血液蛋白结合是MR血管成像的优势，但晚期Gd增强，特别是非缺血性增强，似乎受到了影响。结论本病例报告建议谨慎选择造影剂，特别是在临床试验中将淀粉样蛋白和CMR作为探索性终点的新疗法的情况下。
BackgroundCardiac amyloidosis is a progressive but underdiagnosed and underappreciated cause of heart failure. In the last few years, cardiovascular magnetic resonance (CMR) has become the gold standard for non invasive diagnosis of cardiac amyloidosis with the characteristic subendocardial late gadolinium enhancement.Case presentationWe describe a case of a patient who, in the process of aligning protocols for a trial between different centers, had a paired study with two different contrast agents, Dotarem® and MultiHance®. MultiHance® surprisingly failed to demonstrate the characteristic imaging pattern, showing only non specific late gadolinium enhancement at the inferior right ventricular insertion point and different myocardial extracellular volume fraction compared to the one obtained with Dotarem®. MultiHance® is used by many centres, because its partial blood protein binding is a strength for MR angiography, but late gadolinium enhancement, particularly non-ischemic, appears to be compromised.ConclusionsThis case report suggests that contrast agents should be selected with caution, especially with new therapies lining up for amyloid and CMR being used as exploratory end point in clinical trials.