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Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: axial non-contrast chest computed tomography angiography (CTA) with ECG-gating (slice thickness of 0.6 mm, 100 kV, 236 mAs) performed with Somatom Definition Flash (Siemens Healthcare, Erlangen, Germany).
Findings: hyperdense mass at the level of the mitral valve annulus with peripheral calcifications.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: axial contrast-enhanced chest computed tomography angiography (CTA) with ECG-gating (slice thickness of 0.6 mm, 100 kV, 236 mAs) in arterial phase after contrast agent administration (Iomeron 400 mg iodine/ml, Bracco, 100 ml at 6 ml/s), performed with Somatom Definition Flash (Siemens Healthcare, Erlangen, Germany).
Findings: hyperdense mass at the level of the mitral valve annulus with peripheral calcifications and no enhancement after contrast agent administration.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
T2-weighted turbo spin echo black blood spectral pre-saturation with inversion recovery (TR 1800 ms, TE 70 ms, flip angle 90, slice thickness 8 mm) sequence in short axis view.
Findings: hypointense solid mass extending along the posterior mitral annulus; poor image quality due to motion artifacts.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 2.5 ms, TE 1.2 ms, flip angle 60, slice thickness 6 mm) sequence in two chamber view before the administration of contrast agent.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 2.5 ms, TE 1.2 ms, flip angle 60, slice thickness 6 mm) sequence in four chamber view before the administration of contrast agent.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 3.3 ms, TE 1.6 ms, flip angle 60, slice thickness 6 mm) sequence in short axis view before the administration of contrast agent.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
First-pass perfusion (TE 1.1, TR 2.5) sequence in short axis view post intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: mitral valve mass with no contrast enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 1.6 ms, TE 3.3 ms, flip angle 50, slice thickness 6 mm) sequence in two chamber view post intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity and no contrast enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 1.7 ms, TE 3.5 ms, flip angle 60, slice thickness 6 mm) sequence in four chamber view post intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity and no contrast enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Cine balanced turbo field echo bTFE (TR 1.7 ms, TE 3.3 ms, flip angle 60, slice thickness 6 mm) sequence in three chamber view post intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus, with low signal intensity and no contrast enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
Look-Locker short axis single-slice sequence (TR 8.1, TE 3,5) acquired approximately 10-15 minutes after intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s, to select the optimal inversion delay time to null the signal of normal myocardium.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
T1 fast field echo phase sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) sequence in short axis view acquired approximately 10-15 minutes after intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus with a peripheral ring of enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
T1 fast field echo phase sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) sequence in two chamber view acquired approximately 10-15 minutes after intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus with a peripheral ring of enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
T1 fast field echo phase sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) sequence in three chamber view acquired approximately 10-15 minutes after intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus with a peripheral ring of enhancement.


Click 62 y/o female with caseous calcification of the mitral annulus.
Technique: Cardiac MRI, Ingenia 1.5 T (Philips Healthcare, Best, The Netherlands) scanner with a SENSE torso phased-array coil.
T1 fast field echo phase sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) sequence in four chamber view acquired approximately 10-15 minutes after intra-venous contrast administration (Prohance 0.15 mmol/kg, Bayer HealthCare, Germany) infused as bolus at a rate of 5 ml/s pushed by a 40 ml saline at 5 ml/s.
Findings: large solid mass extending along the posterior mitral annulus with a peripheral ring of enhancement.