Detection of myocardial fibrosis in systemic sclerosis by contrast-enhanced magnetic resonance imaging

Purpose: Our study aimed to assess the prevalence and pattern of late gadolinium enhancement (LGE) as an in vivo correlate of myocardial fibrosis in cardiac asymptomatic patients with systemic sclerosis (SSc). Materials and Methods: Cardiac magnetic resonance imaging was successfully performed in 34 patients (30 female, 4 male, mean age of 54±14 years) with proven SSc and in controls with matching age, sex and cardiovascular risk factors. All examinations were performed on a 1.5 T MR system (Avanto, Siemens, Germany). 2D inversion recovery spoiled gradient echo images (TR 8.0 msec, TE4.0 msec, TI 180-240 msec, FA20°, slice thickness 8 mm, in-plane resolution 1.2 × 1.2 mm²) were acquired 10 to 15 min after injection of 0.2 mmol Gd-DTPA per kg body weight to detect myocardial LGE. Results: Poorly defined, patchy as well as well-defined focal areas of LGE were detected predominantly in the mid-myocardial layer of the basal left ventricular segments in 5 of 34 (15%) SSc patients. A focal area of LGE was observed within the apical septum in one control (3%, p > 0.05). LGE was observed in a total of 15 segments of the SSc patients and in 1 segment of the controls (p < 0.005). Conclusion: Our results revealed a significantly higher number of LGE positive segments in patients with SSc compared to matched controls, and demonstrate the ability of contrast-enhanced MRI to detect myocardial fibrosis, the hallmark of scleroderma heart disease, in-vivo.