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J Cardiol 2002 Oct; 40（4）: 145 – 152

Myocardial Enhancement on
Magnetic Resonance Imaging With
Gadolinium-Diethylenetriamine
Pentaacetic Acid and Improvementof Left Ventricular Function in
Patients With Dilated Cardiomyopathy
Masafumi

AKISAWA, MD

Yoshihisa MATSUMURA, MD
Hiroaki KITAOKA, MD
NaohitoJun

YAMASAKI, MD
TAKATA, MD

Yoshinori DOI, MD, FJCC
Abstract ─────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
Objectives. This study evaluated the significance of myocardial gadolinium-diethylenetriamine pentaacetic acid
（Gd-DTPA）enhancement on magnetic resonance imaging for the improvement of left ventricular function in patients with dilated cardiomyopathy.
Methods. Twenty-seven patients with dilated cardiomyopathy（mean age 59 ± 11 years）were studied.
The magnitude of myocardial Gd-DTPA enhancement was quantitatively assessed using signal intensity
ratio and compared to changes in left ventricular function and adverse cardiac events during a relatively
long follow-up period.
Results. Regional high signal intensity ratio, defined as ＞
− mean ＋ 2SD in seven normal subjects, wasfound in 14 patients : in three or more regions out of five myocardial regions analyzed in six patients（extensive enhancement）and in only one or two regions in eight patients（limited enhancement）. The
remaining 13 patients had no high signal ratio in any of the five regions analyzed（no enhancement）.
During the follow-up period of 3.9 ± 1.9 years, four patients died of cardiac causes. The incidence of cardiac death was 33.3% in patients with extensive enhancement, 12.5% in those with limited enhancement
and 7.7% in those without enhancement, but there was no statistical difference. Mild improvement in fractional shortening was observed in patients without enhancement during the follow-up（19 ± 4% → 27 ±
10%, p ＝ 0.03）.
Conclusions. Evaluation of myocardial Gd-DTPA enhancement on magnetic resonance imaging may
provide useful prognostic information for patients with dilated cardiomyopathy.
──────────────────────────────────────────────────────────────────────────────────────────────────────────────────────J Cardiol 2002 Oct ; 40（4）: 145−152

Key Words
Cardiomyopathies, dilated

Prognosis

INTRODUCTION
Idiopathic dilated cardiomyopathy usually has a

Magnetic resonance imaging Gd-DTPA

poor prognosis1−4）. However, some patients withdilated cardiomyopathy show an improvement inleft ventricular systolic function5−11）. The clinical──────────────────────────────────────────────
高知医科大学 老年病科・循環器科 : 〒 783−8505 高知県南国市岡豊町小蓮
Department of Medicine and Geriatrics, Kochi Medical School, Kochi
Address for correspondence : DOI Y, MD, FJCC, Department of Medicine and Geriatrics, Kochi Medical School, Kohasu, Oko-cho,Nankoku, Kochi 783−8505
Manuscript received March 8, 2002 ; revised August 19, 2002 ; accepted August 19, 2002

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146

Akisawa, Matsumura, Kitaoka et alcharacteristics including hemodynamic variables
determined at initial diagnosis are not associatedwith improvement in left ventricular systolic function5,7,8）, although pharmacological stress echocardiography with low dose dobutamine may be usefulfor predicting the recovery of systolic function12）.
Magnetic resonance imaging with gadoliniumdiethylenetriamine pentaacetic acid（ Gd-DTPA）
administration may have a potential role in characterizing abnormal myocardial tissue such as
myocardial fibrosis, ischemia and degeneration of
myocytes 13−17）, and is useful for assessing theseverity of myocardial changes and left ventricular
dysfunction in dilated and hypertrophic cardiomyopathy18−23）. However, the prognostic value of thisnoninvasive method is not known. This study
assessed magnetic resonance imaging with GdDTPA administration as a method for predicting therecovery of systolic function and evaluating theclinical outcome in patients with dilated cardiomyopathy.
SUBJECTS AND METHODSPatients population
This study included 27 consecutive patients withdilated cardiomyopathy（ 21 men and 6 women,
aged 26 to 76 years［mean ± SD, 59 ± 11 years］）
and seven healthy volunteers, seven men aged 26 to
33 years［mean ± SD, 31 ± 3 years］）. All patientswere in New York Heart Association Class Ⅱ（n ＝23）or Ⅲ（n ＝ 4）at the initial evaluation. A history
was taken carefully from all the patients, followed
by a physical examination, blood test, chest radiography, standard electrocardiography, 24-hour ambulatory Holter monitoring, echocardiography, andcardiac catheterization, including coronary angiography and biplane left ventriculography. Patientswith acute myocarditis, significant coronary arterystenosis, valvular disease, or left ventricular enddiastolic volume below 85 ml/m2 were excluded.
Magnetic resonance imaging
All magnetic resonance images were obtainedwith a commercially available 1.5-tesla superconducting magnet scanner（ SIGNA, General
Electric）. The imaging sequence used was electrocardiography（ECG）-gated spin-echo with a flip
angle of 90 °and echo time of 20 msec. The repetition time was dependent on the heart rate, andequivalent to the R-R interval of the ECG. Imaging
was done during systole using a trigger delay of

231 ± 76（mean ± SD, range 55−385）msec after
the R wave of the ECG. Imaging was taken in theleft ventricular long-axis plane, which corresponded to the left ventriculogram in the 30 °right anterior oblique projection. A multislice technique wasused with a slice thickness of 10 mm（2.5 mm gap
between slices）. A matrix size of 256 × 128 pixels
was used for reconstruction. After the baselinemagnetic resonance imaging, the imaging was
repeated with the same pulse sequences 10 min
after intravenous administration of 0.1 mM/kg of
Gd-DTPA. The baseline and Gd-DTPA-enhanced
images were then compared using the long-axis
image for analysis.
Image analysis
Quantitative evaluation of contrast enhancement
was performed by computer assisted determinationof the signal intensity. Regions of interest with anarea of 0.92 cm2 were used for analysis. Six regionsof interest were chosen, five in the left ventricularmyocardium and one in the skeletal muscles of an
upper limb. The signal intensity was measured foreach region, taking care not to include signals fromintracavitary flow or epicardial fat. The correctedsignal intensity of the myocardium was calculatedby dividing the signal intensity of the myocardiumby that of skeletal muscles24,25）. The signal intensity
ratio of the myocardium was calculated as follows :Signal intensity ratio ＝ Post-contrast corrected signal intensity/Pre-contrast corrected signal intensity

The mean value of the signal intensity ratios wascalculated by dividing the sum of the regional signal intensity ratio by the number of regions in eachsubject. One of 135 regions was excluded due topoor visualization.
Echocardiography
TOSHIBA SSH160A ultrasound equipment witha 2.5- or 3.75-MHz transducer was used to derivestandard views for the comprehensive, two-dimensional, spectral pulsed-wave Doppler, and color
flow Doppler studies. The standard technique was
employed for measuring the size of the left ventricle. Left ventricular fractional shortening was calculated as previously described26）. Left ventricular
inflow velocities were obtained from the apicalfour-chamber view, using pulsed-wave Doppler
echocardiography, by placing the sample volume at
the leaflet tips of the mitral valve27）. The Doppler
measurements included the left ventricular inflow
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Magnetic Resonance Imaging in Dilated Cardiomyopathy

147

Fig. 1 Magnetic resonance images
Upper row : Vertical long-axis magnetic
resonance images of a patient with extensive Gd-DTPA enhancement, obtained
before（ left）and after（right）injection of
Gd-DTPA. Increased signal intensity wasobserved in the anteroapical region.
Lower row : Vertical long-axis magnetic
resonance images of a patient without GdDTPA enhancement, obtained before（left）
and after（right）injection of Gd-DTPA. No
significant increase in signal intensity wasobserved.
Gd-DTPA ＝ gadolinium-diethylenetriamine pentaacetic acid.

early（E）and late（A）diastolic peak velocities, aswell as the E/A ratio for each cardiac cycle.
Holter electrocardiography
All patients underwent 24-hour ambulatory ECG
monitoring. Nonsustained ventricular tachycardia
was defined as ＞
− 3 consecutive ventricular premature complexes at a mean rate of more than 120
beats/min.
Cardiac catheterization
Left heart catheterization and coronary angiography were performed in all patients. Biplanar left
ventriculography was performed in the 30 °rightanterior oblique and 60 °left anterior oblique projections. Significant coronary artery stenosis was
defined as ＞
− 50% reduction of the luminal diameterin the left anterior descending, left circumflex or
right coronary arteries.
Follow-up
The mean（± SD）follow-up period was 3.9 ±1.9 years. Clinical outcome was obtained in all
patients. Follow-up echocardiography was obtainedin all patients except four patients with Gd-DTPA
enhancement who died during the follow-up.

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Statistical analysis
Results are expressed as mean ± SD. A chisquare test was used to compare categoric variables, and Student s t-test to compare continuous
variables. A paired t-test was used to compare thechanges in signal intensity. A p value ＜ 0.05 wasconsidered statistically significant.
RESULTS
Signal intensity ratio of the myocardium
The signal intensity ratio of the five myocardial
regions ranged from 1.013 ± 0.011 to 1.021 ±0.019 in patients with dilated cardiomyopathy, andfrom 1.005 ± 0.009 to 1.009 ± 0.006 in healthy
volunteers. The mean value of signal intensity ratio
was higher in patients with dilated cardiomyopathy
than in healthy volunteers（ 1.016 ± 0.011 vs
1.006 ± 0.007, p ＜ 0.05）.
Gd-DTPA enhancement in dilated cardiomyopathy
High signal intensity ratio was defined as aregional signal intensity ratio ＞＋ 2SD of− mean18）
seven normals, as reported previously . In patientswith dilated cardiomyopathy, 36 myocardial
regions had a high signal intensity ratio（Gd-DTPA
enhancement）, whereas 98 myocardial regions
were without enhancement（Fig. 1）. FourteenJC40407 02.11.27 3:47 PM ページ 148

148

Akisawa, Matsumura, Kitaoka et al

Fig. 2 Results of magnetic resonance imaging with Gd-DTPA and clinical outcome in 27 patients with dilated cardiomyopathy
DCM ＝ dilated cardiomyopathy ; pt（s）＝patient（s）. Other abbreviation as in Fig.
1.

Table 1 Baseline and echocardiographic characteristics
Enhancement（n＝14）

No enhancement（n＝13）

p value

Age（yr）

60±9

58±13

NS

Male

11（79）

10（77）

NS

LVDd
（mm）

63±6

61±5

NS

LVDs（mm）

53±7

49±6

NS

FS
（%）

16±5

19±4

0.05

E
（cm/sec）

68±38

51±14

NS

E/A

1.4±1.1

0.8±0.3

NS

Digitalis

10（71）

10（77）NS

Diuretics

12（86）

11（85）

NS

ACE-inhibitor

11（79）

11（85）

NS

Beta-blocker

2（14）

4（31）

NS

Antiarrhythmic drugs

5（36）

2（15）

NS

Medication

Continuous values mean±SD.（ ）: %.
LVDd＝left ventricular diastolic dimension ; LVDs＝left ventricular systolic dimension ; FS＝fractional
shortening ; E＝early diastolic peak velocity ; A＝late diastolic peak velocity ; ACE＝angiotensin converting
enzyme.

patients had Gd-DTPA enhancement in at least one
region, of whom six patients had Gd-DTPA
enhancement in three or more regions（extensive
enhancement）and eight patients in one or two
regions（limited enhancement）. The remaining 13
patients had no regional high signal intensity ratio
in any of the five regions（no enhancement ; Fig.
2）. Basic and echocardiographic characteristics areshown in Table 1. Fractional shortening was betterin patients without enhancement at the baseline（p ＜ 0.05）. Other variables did not show any dif-ference between the two groups.
Adverse clinical outcome
During the follow-up period of 3.9 ± 1.9 years（0.5−7.1 years）, four patients died of cardiac causes ; three from heart failure and one from sudden
death. One patient died of malignant disease. There
were no differences in the use of cardioactive medications between patients with Gd-DTPA enhancement and those without enhancement（Table 1）.
The incidence of cardiac death was not statistically
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Magnetic Resonance Imaging in Dilated Cardiomyopathy

149

Table 2 Changes in left ventricular function in patients with and without Gd-DTPA enhancementNoenhancement（n＝13）

Extensive and limited
enhancement（n＝10）★
Baseline

Follow-up

Baseline

Follow-up

LVDd
（mm）

63±5

63±15

61±5

57±7

LVDs（mm）

52±6

52±17

49±6

42±11＊

FS
（%）

17±3

18±7

19±4

27±10＊＊

Values are mean±SD. ★Follow-up echocardiography was not obtained in four patients who died during the followup.
＊p＝0.09, ＊＊p＝0.03.
Abbreviations as in Fig. 1, Table 1.

Ventricular tachycardia
Ventricular tachycardia was found by Holter
ECG in three of six patients with extensive
enhancement（50%）, in three of eight patients withlimited enhancement（38%）, and in three of 13
patients without enhancement（23%）.
DISCUSSIONS

Fig. 3 Changes in fractional shortening in patients with
Gd-DTPA enhancement（extensive plus limited）
and in those without enhancement during thefollow-up period of 3.9 ± 1.9 years
Abbreviation as in Fig. 1.

different in patients with extensive enhancement（33.3%）, compared to those with limited enhancement（12.5%）and those without enhancement（7.7% ; Fig. 2）.
Changes in left ventricular function
Follow-up echocardiography showed no significant difference in left ventricular diastolic and systolic dimensions, and fractional shortening at theinitial evaluation between patients with extensive
or limited enhancement and those without enhancement（Table 2）. At the last follow-up, a significant
improvement in fractional shortening was observedin patients without enhancement（19 ± 4% → 27 ±
10%, p ＝ 0.03）compared to those with enhancement（Fig. 3）, although left ventricular size showedno significant change in either group.
J Cardiol 2002 Oct; 40（4）: 145 – 152

The most important finding of this study is thatfractional shortening improved with medical therapy in dilated cardiomyopathy patients without
myocardial Gd-DTPA enhancement during the relatively long follow-up period. Also, two of the six
patients with extensive myocardial enhancement atbaseline died of cardiac causes.
Dilated cardiomyopathy, which is usually characterized by dilated left ventricle and impaired
pump function, has a poor prognosis1−4）. Early retrospective studies from tertiary referral centersfound mortality rates were 25% to 30% at 1 year
and approximately 50% at 5 years1,2）. However,more recent observations suggest a better prognosis, with a 5-year mortality of 20% 3,4）. Referralbias, earlier detection of the disease, and better
treatments with angiotensin coverting enzymeinhibitors and beta-blockades may be related to thisimprovement in prognosis. Although the majority
of deaths occur within 2 to 3 years of the onset ofsymptoms, some patients may have a prolonged
period of clinical stability. Moreover, spontaneous
improvement in left ventricular systolic function
occurs in 20% to 45% of patients with dilated cardiomyopathy5−7）. This improvement in left ventricular function is independent of the hemodynamic
parameters determined at the initial examination5,7,8）. Although the extent of myocardial fibrosis
in endomyocardial biopsies has been helpful inJC40407 02.11.27 3:47 PM ページ 150

150

Akisawa, Matsumura, Kitaoka et alassessing later improvement in left ventricularfunction8−11）, the noninvasive prediction of such
improvement is desirable and of clinical importance, particularly in relation to the indication forheart transplantation28）.
Gd-DTPA is rapidly distributed from theintravascular to the extracellular fluid compartment
by biological membranes due to its hydrophilicity,
charge and molecular weight, and is then excreted
unchanged through the kidney24）. About 50% of theinjected Gd-DTPA is cleared from the capillaries
during the first pass. Gd-DTPA with a biologicalhalf-life of 20 min is largely washed out in the normal tissue by 10−15 min after injection. Gd-DTPA
enhancement is influenced by regional Gd-DTPA
concentration and proton density24,29）. Gd-DTPA
concentration may be related to several factors,
including differences in the blood flow, vascularpermeability, and interstitial structure. The effect ofenhancement is determined by the amount of vascularization, cellular damage, and size of the extracellular space of the myocardium.
Magnetic resonance imaging with Gd-DTPA isuseful for myocardial tissue characterization inpatients with myocardial infarction, and hypertrophic and dilated cardiomyopathy17−23）. A case of
hypertrophic cardiomyopathy showed high signal
intensity of the hypertrophic ventricular wall20）.
This high signal intensity of the myocardium wasalso found in patients with hypertrophic cardiomyopathy and impaired left ventricular function22,23）.
Myocardial fibrosis and subendocardial ischemia
are thought to be the cause of increased signal
intensity in the myocardium. Extensive myocardial
Gd-DTPA enhancement has been correlated to
impaired systolic and diastolic function in patientswith dilated cardiomyopathy, so the Gd-DTPA
enhancement of the myocardium may indicate
advanced myocardial changes such as extensive
要and severe fibrosis 18,19）. The absence of such
myocardial enhancement in magnetic resonanceimaging may suggest less severe myocardialchanges, as indicated by the present study. The prediction of adverse clinical outcome based on magnetic resonance imaging with Gd-DTPA seems difficult and larger studies are needed to define thesignificance of extensive myocardial Gd-DTPA
enhancement in the prediction of adverse outcome
in patients with dilated cardiomyopathy.
The limitations of this study include the small
number of patients studied. Myocardial enhancement was quantified on a long-axis view of themagnetic resonance imaging. Changes in myocardial intensity were distributed more or less uniformly over the entire myocardium in patients withdilated cardiomyopathy, although focal processes
may have affected our quantitative analysis. Also,
myocardial biopsies were not performed, although
we excluded patients with clinical indications of
myocarditis or secondary myocardial disease.
In conclusion, magnetic resonance imaging with
Gd-DTPA may be useful for myocardial tissue
characterization and the noninvasive prognosis inpatients with dilated cardiomyopathy. Absence of
myocardial Gd-DTPA enhancement is suggestiveof a prolonged period of clinical stability and future
improvement of left ventricular systolic function.
Such clinical information, together with information from low dose dobutamine stress echocardiography, is particularly useful when clinicians have todecide whether or not heart transplantation is needed.
Acknowledgments
We thank Professor Shoji Yoshida and Dr. Akihiro Sawada,
Department of Radiology, Kochi Medical School, for their pertinent
advice throughout the study.

約

拡張型心筋症における磁気共鳴画像心筋ガドリニウム−ジエチレントリアミン
五酢酸造影効果と左室機能改善

目

秋澤

雅史

松村

敬久

北岡

裕章

山崎

直仁

高 田

淳

土居

義典

的 : 拡張型心筋症における磁気共鳴画像心筋ガドリニウム（Gd）-ジエチレントリアミン五酢酸（DTPA）造影効果と左室機能改善の関連性について検討する．

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JC40407 02.11.27 3:47 PM ページ 151

Magnetic Resonance Imaging in Dilated Cardiomyopathy

方151

法 : 拡張型心筋症患者 27 例（平均年齢 59 ± 11 歳）を対象として，磁気共鳴画像の心筋 Gd-

DTPA 造影効果の程度を定量的に評価し，長期経過観察後の左室機能変化および心事故との関連性を検討した．
結果 : 心筋の信号強度の増強（正常 7 例の平均＋ 2 標準偏差以上と定義）は，解析を行った長軸

画像 5 領域の中で，14 例の患者にみられた．そのうち，6 例では 3 領域以上に信号強度の増強（広範囲造影）が認められた．8 例では 2 領域以下（小範囲造影）であった．残り 13 例では，5 領域いずれにも信号強度の増強は認られめなかった（非造影）．3.9 ± 1.9 年の経過観察で，4 例の心臓死が確認された．心臓死の頻度は 3 群間で有意差を認めなかったが，広範囲造影群（33.3%）で小範囲造影群（12.5%）ないし非造影群（7.7%）より多い傾向を認めた．また，左室短縮率は非造影群でのみ改善を示した（19 ± 4% → 27 ± 10%，p ＝ 0.03）．
結論 : 磁気共鳴画像における Gd-DTPA 造影効果の定量評価は，拡張型心筋症患者の予後を評価するうえで，臨床的に有用な情報を提供するものと考えられる．

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References
1）Fuster V, Gersh BJ, Giuliani ER, Tajik AJ, Brandenburg
RO, Frye RL : The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol 1981 ; 47 : 525−531
2）Ikram H, Williamson HG, Won M, Crozier IG, Wells EJ :The course of idiopathic dilated cardiomyopathy in New
Zealand. Br Heart J 1987 ; 57 : 521−527
3）Sugrue DD, Rodeheffer RJ, Codd MB, Ballard DJ, Fuster
V, Gersh BJ : The clinical course of idiopathic dilated cardiomyopathy : A population-based study. Ann Intern Med
1992 ; 117 : 117−1234）Abelmann WH : Classification and natural history of primary myocardial disease. Prog Cardiovasc Dis 1984 ; 27:
73−945）Francis GS, Johnson TH, Ziesche S, Berg M, Boosalis P,
Cohn JN : Marked spontaneous improvement in ejection
fraction in patients with congestive heart failure. Am J Med
1990 ; 89 : 303−3076）Steimle AE, Stevenson LW, Fonarow GC, Hamilton MA,
Moriguchi JD : Prediction of improvement in recent onset
cardiomyopathy after referral for heart failure. J Am Coll
Cardiol 1994 ; 23 : 553−559
7）Cross AM Jr, Steenbergen C, Higginbotham MB :Recovery of left ventricular function in acute nonischemic
congestive cardiomyopathy. Am Heart J 1995 ; 129 : 24−
308）Figulla HR, Rahlf G, Nieger M, Luig H, Kreuzer H :Spontaneous hemodynamic improvement or stabilization
and associated biopsy findings in patients with congestive
cardiomyopathy. Circulation 1985 ; 71 : 1095−11049）Yamada T, Fukunami M, Ohmori M, Iwakura K, Kumagai
K, Kondoh N, Minamino T, Tsujimura E, Nagareda T,
Katoh K, Hoki N : Which subgroup of patients with dilated
cardiomyopathy would benefit from long-term β-blocker
therapy? : A histologic viewpoint. J Am Coll Cardiol 1993 ;21 : 628−633
10）Regan TJ : Alcoholic cardiomyopathy. Prog Cardiovasc
Dis 1984 ; 27 : 141−152
11）Schwarz F, Mall G, Zebe H, Blickle J, Derks H, Manthey J,
Kubler W : Quantitative morphologic findings of the

J Cardiol 2002 Oct; 40（4）: 145 – 152

myocardium in idiopathic dilated cardiomyopathy. Am J
Cardiol 1983 ; 51 : 501−506
12）Kitaoka H, Takata J, Yabe T, Hitomi N, Furuno T, Doi
YL : Low dose dobutamine stress echocardiography predicts the improvement of left ventricular systolic function
in dilated cardiomyopathy. Heart 1999 ; 81 : 523−52713）Weinmann HJ, Brasch RC, Press WR, Wesbey GE :Characteristics of gadolinium-DTPA complex : A potential
NMR contrast agent. AJR Am J Roentgenol 1984 ; 142 :619−624
14）Brasch RC, Weinmann HJ, Wesbey GE : Contrastenhanced NMR imaging : Animal studies using gadolinium-DTPA complex. AJR Am J Roentgenol 1984 ; 142 :625−630
15）Carr DH, Brown J, Bydder GM, Steiner RE, Weinmann HJ,
Speck U, Hall AS, Young IR : Gadolinium-DTPA as a contrast agent in MRI : Initial clinical experience in 20
patients. AJR Am J Roentgenol 1984 ; 143 : 215−22416）Brown JJ, Higgins CB : Myocardial paramagnetic contrast
agents for MR imaging. AJR Am J Roentgenol 1988 ; 151 :
865−87117）de Roos A, Doornbos J, van der Wall EE, van Voorthuisen
AE : MR imaging of acute myocardial infarction : Value of
Gd-DTPA. AJR Am J Roentgenol 1988 ; 150 : 531−534
18）Matsumura Y, Takata J, Sawada A, Furuno T, Yoshida S,
Doi YL : Magnetic resonance imaging in dilated cardiomyopathy : Significance of extensive myocardial gadoliniumDTPA enhancement. J Noninvas Cardiol 1999 ; 3 : 154−
16019）Koito H, Suzuki J, Ohkubo N, Ishiguro Y, Iwasaka T,
Inada M : Gadolinium-diethylenetriamine pentaacetic acidenhanced magnetic resonance imaging of dilated cardiomyopathy : Clinical significance of abnormal high signal
intensity of left ventricular myocardium. J Cardiol 1996 ;
28 : 41−49（in Jpn with Eng abstr）
20）Farmer D, Higgins CB, Yee E, Lipton MJ, Wahr D, Ports
T : Tissue characterization by magnetic resonance imaging
in hypertrophic cardiomyopathy. Am J Cardiol 1985 ; 55:
230−232
21）Tsukihashi H, Ishibashi Y, Shimada T, Hatano J, Tanabe K,
Ooyake N, Morioka S, Moriyama K : Changes in gadolini-JC40407 02.11.27 3:47 PM ページ 152

152

Akisawa, Matsumura, Kitaoka et alum-DTPA enhanced magnetic resonance signal intensity
ratio in hypertrophic cardiomyopathy. J Cardiol 1994 ; 24:（in Jpn with Eng atstr）
185−19122）Nishimura T, Nagata S, Sakakibara H : Magnetic resonanceimaging in familial hypertrophic cardiomyopathy associated with abnormal thallium perfusion and cardiac enzyme.
Jpn Circ J 1988 ; 52 : 395−40023）Koito H, Suzuki J, Nakamori H, Ohkubo N, Wakayama Y,
Iwasaka T, Inada M, Katoh T : Clinical significance ofabnormal high signal intensity of left ventricular myocardium by gadolinium-diethylenetriamine pentaacetic acidenhanced magnetic resonance imaging in hypertrophic cardiomyopathy. J Cardiol 1995 ; 25 : 163−170（in Jpn withEng abstr）
24）Schmiedl U, Moseley ME, Ogan MD, Chew WM, Brasch
RC : Comparison of initial biodistribution patterns of GdDTPA and albumin（Gd-DTPA）using rapid spin echo MR
imaging. J Comput Assist Tomogr 1987 ; 11 : 306−313
25）Williams CT, Stack JP, Loveday B, Waston Y, Isherwood
I : Magnetic resonance imaging of the mini-pig heart : The

effect of gadolinium-DTPA on normal myocardium. Br J
Radiol 1988 ; 61 : 596−599
26）Sahn DJ, DeMaria A, Kisslo J, Weyman A, The committee
on M-mode standardization of the American Society of
Echocardiography : Recomendations regarding quantitationof M-mode echocardiography : Results of a survey of
echocardiographic measurements. Circulation 1978 ; 58:
1072−1083
27）Appleton CP, Hatle LK, Popp RL : Relation of transmitralflow velocity patterns to left ventricular diastolic function :New insights from a combined hemodynamic and Doppler
echocardiographic study. J Am Coll Cardiol 1988 ; 12 :426−44028）Dec GW, Fuster V : Idiopathic dilated cardiomyopathy. N
Engl J Med 1994 ; 331 : 1564−157529）Schaefer S, Malloy CR, Katz J, Parkey RW, Buja LM,
Willerson JT, Peshock RM : Gadolinium-DTPA-enhanced
nuclear magnetic resonance imaging of reperfused
myocardium : Identification of the myocardial bed at risk. J
Am Coll Cardiol 1988 ; 12 : 1064−1072

J Cardiol 2002 Oct; 40（4）: 145 – 152