0:00

And the case the case number three here has I'm

0:03

going to show some still images here first.

0:06

Oh, actually the video is playing so which is good. This is the

0:09

history here is a 55 year old

0:12

man admitted admitted with acute chest pain here. We

0:15

see a short axis image.

0:18

Short access video just notice the left ventricle right

0:21

ventricle entry wall septum in free

0:24

wall and the lateral wall.

0:25

I'm now going to go on to another video

0:28

which is delayed enhancement date

0:31

gallium enhancement.

0:33

So we have a combination of wall motion

0:36

and late galum enhancement. I'm going to let this late Gallery enhancements

0:39

image play.

0:41

And the first question based on this case is

0:44

perhaps the organizers can

0:47

put the first question up here just move this. Okay. So

0:50

the question one is regarding the

0:53

cause of the Imaging findings.

0:57

If we can just take I'm in the interest sometime. I'm

1:00

not going to read all through all the choices, but

1:02

we'll discuss the correct choice in a few

1:05

seconds. Once the audience has had time to answer.

1:08

Which of the following is the correct statement? Okay, the

1:11

correct answer is B good excellent. So patient

1:14

has had a my card in function the LED distribution.

1:18

And should be managed. Medically. The reason is notice

1:21

the bright area involving the southern accordion the

1:24

entry wall entry septum antrilateral and

1:27

all the apical segments notice. There's almost

1:30

full thickness. I'm going to play is still image now. I'm just

1:33

going to keep it still image now to emphasize the features.

1:37

Notice the near transmiral late gallium enhancement

1:40

in the LED distribution. This is a non-viable and

1:43

three of my Kindle infant due to left entry to

1:46

the LED left Antony decent

1:49

in coronary artery obstruction. And because it's non-viable

1:52

the thickness of the enhanced tissue and

1:55

in addition, there's wall thinning. It's greater than

1:58

50% This is non-viable It's unlike to recover with surgical management.

2:01

The patient should be managed medically. So

2:04

it's a LED distribution currently in

2:07

fatal enhancement involves into

2:10

cardium, which is a typical finding in

2:13

in fact, and it's in coronary artery distribution notably

2:16

the LED distribution.

2:18

And they enhancement is near transmiro indicating

2:21

that it's nonviable in general if enhancements or 50%

2:24

It's non-viable and paste the best management ICD placement

2:28

can be considered in patients who have low ejection fractions, but

2:31

in general if if it does not improve by

2:34

medical management at 3 typically after a time period of

2:37

optimal medical management three to four months after an infant

2:40

of the

2:42

if the ejection fraction is under 35% and

2:46

the patient's risk of certain death and nicely can

2:49

be considered but not immediately at discharge from the hospital. So LED,

2:52

in fact nonviable best management.

2:55

I'm going to keep this image up while we just reviewed two more questions regarding this

2:59

case, which of the following sequences is used for

3:02

viability Imaging routine clinical practice. So the question is

3:05

pertaining to this sequence here. What what

3:08

sequence is it T1

3:11

weighted spin echo28. It's been Echo T1

3:14

in version recovery grade Neko T1 mapping or a

3:17

non contrast steady state representation sequence. Let's have

3:20

a poll of what people think this particular sequence.

3:23

It's a bread and butter sequence for County comma

3:26

Later, I live enhancement and delayed and enhancement can be

3:29

used describe a different terms.

3:32

Okay. Well the correct answer according to

3:35

the poll is T1 weighted Terrace Post-it turbo spinach and unfortunately,

3:38

that's not right. The correct answer is C. It's a

3:41

T1 weighted post contrast inversion recovery sequencer

3:44

in version prepounces used to suppress the normal

3:47

myocardium. So

3:48

it's a T1 weighted sequence because we give gamblingium and

3:51

gadolinium is T1 shocking agents. So we have to use a excuse me.

3:54

So we have to use a T1 base sequence.

3:58

It's an inversion recovery sequence. We suppressed

4:01

the normal myocardium and abnormal. Myocardium

4:04

is bright because the normal my economy suppressed and

4:07

we use a t-1 weighted sequence as galim is

4:10

T1 shortening agent and gadolinium is

4:14

retained in areas of abnormal myocardium typically in

4:17

infants fibrotic tissue infiltrated tissue. And

4:20

so those areas become bright.

4:22

It's T1 weighted post contrast inversion recovery. The inversion recovery

4:25

pre-pulses used to suppress normal my economy.

4:28

Okay, the last question pertaining to this case is

4:32

Which of the following statements is incorrect regarding

4:35

the applications of cardiacomori nishchemical

4:38

disease, so we're looking for an incorrect statement.

4:41

Okay good. So cardiacomar is

4:44

not the test of choice for direct and atomically evaluation

4:47

currently stenosis spatial institutions under 1 millimeter

4:50

typically can be obtained only with cardiac

4:53

CT or with capita and geography and those

4:56

are needed for evaluation of direct anatomical

4:59

snows in the coronary arteries. So all the other side advances

5:02

of cardiac Mr. Highest spatial resolution access

5:05

fact

5:06

Higher sensory inspect for detecting. Ischemia

5:09

It's appropriate valuation ventricular size and

5:12

function is chemical disease can identify microvascular obstruction,

5:15

which is a prognostic factor. However to directly identify anatomical

5:18

coronary artery stenosis and obstruction either CT

5:21

or cathode and geography is recommend Mr. Is

5:24

not recommended for that purpose as of now and unliking the near future.

5:27

Okay. Thank you. So that's case number three.

5:30

Don't see any questions. So I think we'll proceed to

5:33

case number four.