MRI of Hypertrophic Cardiomyopathy: Part I, MRI Appearances
Mark W. Hansen1,2 and
Naeem Merchant2
1 Department of Medical Imaging, The Prince Charles Hospital, Rode Rd.,
Chermside, Brisbane, Queensland 4032, Australia.
2 Department of Medical Imaging, Toronto General Hospital, University Health
Network and Mt. Sinai Hospital, Toronto, ON, Canada.
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Fig. 1 —Line diagram of the heart in the left ventricular outflow
tract (LVOT) projection shows typical findings of systolic anterior motion of
the mitral valve. Note displacement of the anterior mitral valve leaflet tip
(red leaflet) into the LVOT. This displacement has resulted in
failure of the valve leaflets to coapt, a turbulent high-velocity jet within
the LVOT, and a posteriorly directed jet of mitral valve regurgitation into
the left atrium.
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Fig. 2A —41-year-old man with asymmetric septal hypertrophic
cardiomyopathy (HCM) and systolic anterior motion of the mitral valve. A
high-velocity jet can be detected as an area of high signal intensity within
the left ventricular outflow tract (LVOT) on the four-chamber view (A)
and as an area of spin dephasing on the LVOT projection (B).
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Fig. 2B —41-year-old man with asymmetric septal hypertrophic
cardiomyopathy (HCM) and systolic anterior motion of the mitral valve. A
high-velocity jet can be detected as an area of high signal intensity within
the left ventricular outflow tract (LVOT) on the four-chamber view (A)
and as an area of spin dephasing on the LVOT projection (B).
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Fig. 2C —41-year-old man with asymmetric septal hypertrophic
cardiomyopathy (HCM) and systolic anterior motion of the mitral valve.
Short-axis oblique steady-state free precession image shows enlarged septal
perforators arising from the left anterior descending artery, a finding
commonly seen in cases of HCM.
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Fig. 2D —41-year-old man with asymmetric septal hypertrophic
cardiomyopathy (HCM) and systolic anterior motion of the mitral valve. Note
delayed enhancement within the anterior and posterior right ventricular
insertion points on the short-axis oblique delayed enhancement image.
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Fig. 3A —36-year-old man with asymmetric septal hypertrophic
cardiomyopathy and systolic anterior motion of the mitral valve. Steady-state
free precession images show displacement of the anterior mitral valve leaflet
into the left ventricular outflow tract (LVOT) accompanied by a high-velocity
spin dephasing jet into the LVOT. There is also a jet of mitral regurgitation
into a moderately enlarged left atrium. Note the area of high signal within
the LVOT on the four-chamber projection. This high signal is a result of high
velocities generated in the outflow tracts of patients with systolic anterior
motion.
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Fig. 3B —36-year-old man with asymmetric septal hypertrophic
cardiomyopathy and systolic anterior motion of the mitral valve. Steady-state
free precession images show displacement of the anterior mitral valve leaflet
into the left ventricular outflow tract (LVOT) accompanied by a high-velocity
spin dephasing jet into the LVOT. There is also a jet of mitral regurgitation
into a moderately enlarged left atrium. Note the area of high signal within
the LVOT on the four-chamber projection. This high signal is a result of high
velocities generated in the outflow tracts of patients with systolic anterior
motion.
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Fig. 3C —36-year-old man with asymmetric septal hypertrophic
cardiomyopathy and systolic anterior motion of the mitral valve. Steady-state
free precession images show displacement of the anterior mitral valve leaflet
into the left ventricular outflow tract (LVOT) accompanied by a high-velocity
spin dephasing jet into the LVOT. There is also a jet of mitral regurgitation
into a moderately enlarged left atrium. Note the area of high signal within
the LVOT on the four-chamber projection. This high signal is a result of high
velocities generated in the outflow tracts of patients with systolic anterior
motion.
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Fig. 3D —36-year-old man with asymmetric septal hypertrophic
cardiomyopathy and systolic anterior motion of the mitral valve. Steady-state
free precession images show displacement of the anterior mitral valve leaflet
into the left ventricular outflow tract (LVOT) accompanied by a high-velocity
spin dephasing jet into the LVOT. There is also a jet of mitral regurgitation
into a moderately enlarged left atrium. Note the area of high signal within
the LVOT on the four-chamber projection. This high signal is a result of high
velocities generated in the outflow tracts of patients with systolic anterior
motion.
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Fig. 5A —Apical hypertrophic cardiomyopathy in a 43-year-old man. Left
anterior oblique (A) and four-chamber (B) views. Note apical
hypertrophy and obliteration of the left ventricular apical cavity on the
four-chamber view.
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Fig. 5B —Apical hypertrophic cardiomyopathy in a 43-year-old man. Left
anterior oblique (A) and four-chamber (B) views. Note apical
hypertrophy and obliteration of the left ventricular apical cavity on the
four-chamber view.
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Fig. 6A —Apical hypertrophic cardiomyopathy with marked left and right
ventricular involvement in a 51-year-old man. Steady-state free precession
images show near obliteration of the apical cavities of both ventricles.
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Fig. 6B —Apical hypertrophic cardiomyopathy with marked left and right
ventricular involvement in a 51-year-old man. Steady-state free precession
images show near obliteration of the apical cavities of both ventricles.
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Fig. 7A —Mid to apical hypertrophic cardiomyopathy with a
"burned out apex" in a 58-year-old man. Diastole (A) and
systole (B) steady-state free precession (SSFP) images in the vertical
long-axis plane. Note hypertrophy of the middle third left ventricle and
formation of an apical aneurysm.
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Fig. 7B —Mid to apical hypertrophic cardiomyopathy with a
"burned out apex" in a 58-year-old man. Diastole (A) and
systole (B) steady-state free precession (SSFP) images in the vertical
long-axis plane. Note hypertrophy of the middle third left ventricle and
formation of an apical aneurysm.
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Fig. 7C —Mid to apical hypertrophic cardiomyopathy with a
"burned out apex" in a 58-year-old man. Small mural thrombus, best
seen on the left anterior oblique delayed enhanced image (C), can also
more subtly be identified on the SSFP projections (A, B, and
D). This patient had normal epicardial coronary arteries on coronary
angiography (not shown).
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Fig. 7D —Mid to apical hypertrophic cardiomyopathy with a
"burned out apex" in a 58-year-old man. Small mural thrombus, best
seen on the left anterior oblique delayed enhanced image (C), can also
more subtly be identified on the SSFP projections (A, B, and
D). This patient had normal epicardial coronary arteries on coronary
angiography (not shown).
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Fig. 8A —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 8B —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 8C —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 8D —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 8E —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 8F —61-year-old woman with masslike hypertrophic cardiomyopathy.
Delayed gadolinium-enhanced images (A and B), steady-state free
precession images (C and D), and first-pass perfusion images
(E and F) reveal a focal area of thickening involving anterior
left ventricular myocardium, which shows a small amount of mid wall
enhancement but perfuses in a uniform manner similar to adjacent normal
myocardium (seen in E and F).
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Fig. 9 —Short-axis oblique projection image in a 52-year-old man with
hypertrophic cardiomyopathy shows typical delayed enhancement involving the
left ventricular septum at both the anteroseptal and posteroseptal right
ventricular insertion points. Note enhancement is patchy and mid wall and
involves areas of grossly thickened myocardium.
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Copyright © 2007 by the American Roentgen Ray Society.
