J Korean Soc Magn Reson Med.  2013 Mar;17(1):33-40. 10.13104/jksmrm.2013.17.1.33.

Delayed Enhancement Magnetic Resonance Imaging Findings in Cardiac Amyloidosis

• Song JH
• Park EA
• Lee W
• Chung JW
• Park JH

• KMID: 1426749
• DOI: http://doi.org/10.13104/jksmrm.2013.17.1.33

Abstract

PURPOSE
To evaluate late gadolinium enhancement (LGE) pattern of left ventricular (LV) myocardium and presence or absence of LGE in other regions of the heart on cardiac magnetic resonance (CMR) imaging in patients diagnosed with cardiac amyloidosis.
MATERIALS AND METHODS
From 2009 to 2011, 9 patients who were suspected cardiac amyloidosis underwent CMR. We retrospectively analyzed the presence or absence of LGE and enhancement pattern in LV myocardium, and the presence or absence of LGE in other chambers as well. Also we measured interatrial septal thickness (IST), relative signal intensities of atrial septum and epicardial fat over the left atrial (LA) cavity on delayed enhanced images. MRI parameters in these patients were compared to those of control group of patients with ischemic heart disease by Wilcoxon rank sum test.
RESULTS
Of nine patients, LGE were found in 8; subendocardial circumferential pattern in 4 and diffuse pattern in 4. LGE in right ventricle was observed in 7. IST was significantly increased in patients with cardiac amyloidosis (P = 0.02). Ratio of atrial septum to LA cavity and ratio of epicardial fat to LA cavity showed a significant difference (P = 0.0002 and P = 0.0006, respectively).
CONCLUSION
In LGE CMR, subendocardial or diffuse enhancement pattern is a typical finding for patients with cardiac amyloidosis. Atrial septum and epicardial fat show relatively increased signal intensities over LA blood cavity.

Keyword

Cardiac MR; Delayed enhancement; Cardiac amyloidosis

MeSH Terms

Amyloidosis
Atrial Septum
Gadolinium
Heart
Heart Ventricles
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Myocardial Ischemia
Myocardium
Retrospective Studies
Gadolinium

Figure

• 

  Fig. 1 Phase-sensitive inversion recovery sequence images showing subendocardial circumferential enhancement pattern in 79-year-old female with cardiac amyloidosis. Four-chamber (a) and short-axis views (b) show global subendocardial circumferential enhancement of left ventricular wall (arrowheads) in a nonvascular distribution. Diffuse enhancement of interartrial septum and both atria was noted (arrows). Of note, diffuse epicardial strong enhancement was associated (white arrows). Ratio of atrial septum to left atrial cavity signal was 1.02 and ratio of epicardial fat signal to left atrial cavity signal was 1.06.

• 

  Fig. 2 Phase-sensitive inversion recovery sequence images showing diffuse transmural enhancement pattern in 51-year-old male with cardiac amyloidosis. Four-chamber view (a) shows diffuse transmural enhancement of left ventricular wall in a nonvascular distribution. Interatrial septum (arrow) and right atrial wall (arrowheads) were thickened with enhancement. Short-axis view (b) shows diffuse enhancement and dark blood pool commonly seen in cardiac amyloidosis. Ratio of atrial septum to left atrial cavity signal and ratio of epicardial fat signal to left atrial cavity signal was 1.18 and 1.26, respectively.

• 

  Fig. 3 Phase-sensitive inversion recovery sequence images showing subendocardial infarction in 57-year-old male with ischemic heart disease. Four-chamber (a) and short axis views (b) show subendocardial delayed enhancement in apical anterior, septal and inferior wall of left myocardium, indicating subendocardial infarction in the territory of right coronary and left anterior descending arteries (arrowheads). Blood signal was increased and interatrial septum (arrows) was relatively dark. Ratio of atrial septum to left atrial cavity signal and ratio of epicardial fat signal to left atrial cavity signal was 0.91 and 0.92, respectively.

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