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Late Myocardial Enhancement in Hypertrophic Cardiomyopathy with Contrast-Enhanced MR Imaging

Jan Bogaert1, Marcelo Goldstein2, Fadi Tannouri3, Jafar Golzarian3 and Steven Dymarkowski1

1 Department of Radiology, Gasthuisberg University Hospital Leuven, Herestr. 49, B-3000 Leuven, Belgium.
2 Department of Cardiology, Hôpital St. Anne, Ave. J. Graindor 66, 1070 Brussels, Belgium.
3 Department of Radiology, Erasmus University Hospital, Brussels, Lenniksebaan 808, 1070 Brussels, Belgium.



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  		Fig. 1A. —75-year-old man with asymmetric septal hypertrophy. Balanced fast field-echo cine MR image obtained at end diastole in cardiac short-axis plane shows thickening of anteroseptal and anterior wall segments. Maximal wall thickness is 32 mm at end diastole.

 


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  		Fig. 1B. —75-year-old man with asymmetric septal hypertrophy. Three-dimensional T1-weighted fast field-echo late-enhancement MR image obtained 12 min after contrast injection shows strong enhancement (arrows) in thickened wall, mainly in mid and subepicardium.

 


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  		Fig. 1C. —75-year-old man with asymmetric septal hypertrophy. Three-dimensional T1-weighted fast field-echo late-enhancement MR image obtained in vertical long-axis plane 15 min after contrast injection shows strong enhancement (arrows) of mid and basal anterior left ventricular wall.

 


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  		Fig. 2A. —77-year-old woman with apical hypertrophic cardiomyopathy. Balanced fast field-echo cine MR image obtained at end diastole in horizontal long axis shows gradual thickening of left ventricular walls toward apex. Maximal apical wall thickness at end diastole is 23 mm.

 


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  		Fig. 2B. —77-year-old woman with apical hypertrophic cardiomyopathy. Three-dimensional T1-weighted fast field-echo late-enhancement MR image obtained 10 min after contrast injection in horizontal long axis shows strong and homogeneous apical enhancement (arrow), mainly in subendocardium and mid wall.

 


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  		Fig. 3. —Graph shows mean wall thickness ± SD at end diastole and at end systole in patients with (•) and without (•) myocardial enhancement on MR imaging.

 


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  		Fig. 4A. —48-year-old man with asymmetric septal hypertrophic cardiomyopathy. Three-dimensional T1-weighted fast field-echo late-enhancement MR image obtained along cardiac short-axis plane displays strong patchy enhancement (arrows) in thickened anteroseptal and anterior wall segments.

 


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  		Fig. 4B. —48-year-old man with asymmetric septal hypertrophic cardiomyopathy. Balanced fast field-echo cine MR image obtained at end diastole along cardiac short-axis plane shows thickened anteroseptal and anterior wall segments. Wall thickness measured 32 mm.

 


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  		Fig. 4C. —48-year-old man with asymmetric septal hypertrophic cardiomyopathy. Balanced fast field-echo cine MR image obtained at end diastole along cardiac short-axis plane at same level as B shows minimal systolic wall thickening. Wall thickness measured 33 mm. Note normal thickening of other wall segments.

 


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  		Fig. 5A. —27-year-old woman with asymmetric septal hypertrophic cardiomyopathy. Three-dimensional T1-weighted fast field-echo late-enhancement MR image shows thickened anteroseptal wall segment (arrows). No late enhancement is seen, and signal intensity in thickened area is similar to that of unthickened segments.

 


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  		Fig. 5B. —27-year-old woman with asymmetric septal hypertrophic cardiomyopathy. Balanced fast field-echo cine MR image obtained at end diastole along cardiac short-axis plane shows hypertrophy of anteroseptal wall, which has thickness of 20 mm.

 


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  		Fig. 5C. —27-year-old woman with asymmetric septal hypertrophic cardiomyopathy. Balanced fast field-echo cine MR image obtained at end diastole along cardiac short-axis plane at same level as B reveals well-preserved systolic wall thickening with end-systolic wall thickness of 27 mm. Note normal contractility of other wall segments.

 

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