engleski

Cardiac magnetic resonance imaging: important diagnostic tool in the evaluation of cardiac amyloidosis

Amyloidosis is a group of diseases caused by the deposition of insoluble fibrillar proteinaceous material in the interstitial space of various organs. Biopsy and histological analysis are the diagnostic gold standard: amyloid fibrils bind Congo red stain, yielding apple-green birefringence under cross- polarized light microscopy. There are several forms of amyloidosis: primary amyloidosis, familial amyloidosis, ATTR amylodosis (production of the unstabile serum protein transthyretin), senile systemic amyloidosis and reactive systemic amyloidosis. Although cardiac involvement is seen with the most forms of amyloidosis, it is most common in patients with primary amyloidosis. Primary amyloidosis is also associated with multiple myeloma, as it is shown in our case report. Patient's clinical features, laboratory testing and electrocardiogram, as well as noninvasive imaging methods, can aid in recognizing patients with amyloidosis. Echocardiography is usually the first cardiac imaging test performed, but cardiac magnetic resonance imaging (MRI) is emerging as a first line modality in patients with suspected cardiac amyloidosis due to its ability to characterize the myocardial tissue, especially on the postcontrast myocardial delayed enhancement sequences. MRI uses steady-state free precession sequences which allows visualization of cardiac morphology, structure and function as well as identification of pericardial and pleural effusions, which may occur as accompanying findings. In order to achieve this goal and to achieve the signal enhancement, intravenous administration of gadolinium contrast is necessary, because gadolinium chelates are distributed within the extracellular space expanded by amyloid infiltration. Shortly after intravenous administration of gadolinium contrast, patients with cardiac amyloidosis have a faster gadolinium clearance from the blood pool, marked by a blood T1 value over time, that was higher than that in controls.

amyloidosis ; cardiac involvement ; diagnostic procedures ; magnetic resonance imaging ; gadolinium.

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