Low T2 value and short T1 in >50% of myocardium T1 scout image are also poor prognostic factors [2]. MRI has sensitivity of 75% to 100% and specificity of 75% to 77% in the diagnosis of cardiac sarcoidosis [54,68,69]. In the acute stage, MRI shows wall thickening, high T2 signal (due to edema), high native T1 and T2 values, RWMA, and LGE. LGE is more common in the basal septal and lateral walls of the LV in a subepicardial or mid myocardial distribution. In the chronic stage, wall thinning, aneurysms, RWMA, and LGE may be seen (mid myocardial, subepicardial, and/or transmural) [70]. LGE correlates with prognosis with a hazard ratio of 32 for lethal events [71]. There is a good response to steroids in patients with lower LGE at initiation of therapy [72]. High native T1 and T2 values provide higher discriminatory accuracy compared with traditional criteria and help in evaluating the response to treatment [73]. Myocardial iron deposition can be reliably quantified using T2* techniques. Myocardial T2* <20 ms indicates significant iron deposition and <10 ms indicates advanced iron deposition with high accuracy [74]. T1-mapping is more reproducible and sensitive, with low T1 values seen in 32% of patients with normal T2* [75]. With appropriate use of chelation therapy, improvements in T2* and LVEF has been reported [76]. The use of MRI has resulted in improved outcomes with death rates declining to 2.3 per 1,000 compared with 7.9 per 1,000 prior to the use of MRI [76]. Linear mid myocardial LGE is seen in 66% of patients with scleroderma, either in the ventricular septum or the LV free wall at the basal and mid levels [77]. Patchy RV insertion enhancement can be seen in 17% of patients (76). LGE is more severe in patients with longer duration of Raynaud disease [78]. High native T1 and ECV values are seen in asymptomatic patients with no known cardiac involvement, due to inflammation, and are
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Low T2 value and short T1 in >50% of myocardium T1 scout image are also poor prognostic factors [2]. MRI has sensitivity of 75% to 100% and specificity of 75% to 77% in the diagnosis of cardiac sarcoidosis [54,68,69]. In the acute stage, MRI shows wall thickening, high T2 signal (due to edema), high native T1 and T2 values, RWMA, and LGE. LGE is more common in the basal septal and lateral walls of the LV in a subepicardial or mid myocardial distribution. In the chronic stage, wall thinning, aneurysms, RWMA, and LGE may be seen (mid myocardial, subepicardial, and/or transmural) [70]. LGE correlates with prognosis with a hazard ratio of 32 for lethal events [71]. There is a good response to steroids in patients with lower LGE at initiation of therapy [72]. High native T1 and T2 values provide higher discriminatory accuracy compared with traditional criteria and help in evaluating the response to treatment [73]. Myocardial iron deposition can be reliably quantified using T2* techniques. Myocardial T2* <20 ms indicates significant iron deposition and <10 ms indicates advanced iron deposition with high accuracy [74]. T1-mapping is more reproducible and sensitive, with low T1 values seen in 32% of patients with normal T2* [75]. With appropriate use of chelation therapy, improvements in T2* and LVEF has been reported [76]. The use of MRI has resulted in improved outcomes with death rates declining to 2.3 per 1,000 compared with 7.9 per 1,000 prior to the use of MRI [76]. Linear mid myocardial LGE is seen in 66% of patients with scleroderma, either in the ventricular septum or the LV free wall at the basal and mid levels [77]. Patchy RV insertion enhancement can be seen in 17% of patients (76). LGE is more severe in patients with longer duration of Raynaud disease [78]. High native T1 and ECV values are seen in asymptomatic patients with no known cardiac involvement, due to inflammation, and are