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Quantification of Left Ventricular Noncompaction and Trabecular Delayed Hyperenhancement with Cardiac MRI: Correlation with Clinical Severity

¹ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.
² Cardiac MR–PET-CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.
³ Present address: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
⁴ Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.

OBJECTIVE. The purpose of this study was to investigate whether MRI can quantify the severity and extent of left ventricular noncompaction and detect trabecular delayed hyperenhancement and whether doing so can show a relationship with clinical stage of disease.

MATERIALS AND METHODS. In a retrospective blinded study, nine patients with left ventricular noncompaction and 10 control subjects had cardiac MRI studies evaluated for the severity and extent of left ventricular noncompaction and the amount and degree of trabecular delayed hyperenhancement on a myocardial segment basis (16-segment model). Findings were correlated with parameters of clinical stage of disease.

RESULTS. Fifty-seven (39%) myocardial segments showed left ventricular noncompaction whereas 22 (17%) showed trabecular delayed hyperenhancement. Significant differences among clinical severity groups were noted in the severity and extent of left ventricular noncompaction at the mid (p < 0.05 and p < 0.005, respectively) and apical levels (p < 0.003 and p < 0.001, respectively), severity of trabecular delayed hyperenhancement at the mid (p < 0.04) and apical levels (p < 0.02), and amount of trabecular delayed hyperenhancement at the apical level (p < 0.006). The extent of left ventricular noncompaction and the amount and degree of trabecular delayed hyperenhancement correlated significantly with ejection fraction (EF) (r = –0.47, –0.53, –0.53, respectively, p < 0.05). The degree of trabecular delayed hyperenhancement was an independent predictor of EF (R² = 0.30, p < 0.0001). Significant differences in the severity of trabecular delayed hyperenhancement were detected among patients with mild and those with moderate and severe clinical stage of disease (p < 0.0001).

CONCLUSION. Cardiac MRI shows trabecular delayed hyperenhancement in left ventricular noncompaction. Evaluating the extent and severity of left ventricular noncompaction and trabecular delayed hyperenhancement may improve the ability of the clinician to predict the clinical stage of disease.

Keywords: cardiomyopathy • left ventricle abnormality • left ventricular noncompaction • MRI • trabecular delayed hyperenhancement

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				J. D. Dodd and R. C. Cury Reply Am. J. Roentgenol., April 1, 2008; 190(4): W274 - W274. [Full Text] [PDF]