MRI of Cardiomyopathy
Elena Belloni1,
Francesco De Cobelli1,
Antonio Esposito1,
Renata Mellone1,
Gianluca Perseghin2,
Tamara Canu1 and
Alessandro Del Maschio1
1 Department of Radiology, Vita-Salute University, San Raffaele Scientific
Institute, Via Olgettina, 60, 20132, Milan, Italy.
2 Internal Medicine Section of Nutrition and Metabolism, Vita-Salute University,
San Raffaele Scientific Institute, Milan, Italy.
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Fig. 1A —19-year-old woman who has had dilated cardiomyopathy
secondary to viral myocarditis since the age of 10 years. Patient experienced
frequent arrhythmias. Morphologic T2-weighted black blood four-chamber
long-axis image with fat suppression shows enlargement of both left ventricle
(LV) (LV end-diastolic volume, 160 mL) and left atrium (arrows). No
alterations in myocardial wall signal intensity were detected.
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Fig. 1B —19-year-old woman who has had dilated cardiomyopathy
secondary to viral myocarditis since the age of 10 years. Patient experienced
frequent arrhythmias. Late-enhancement short-axis (B) and four-chamber
long-axis (C) images shows mesocardial striae of hyperenhancement
located in basal interventricular septum and posteroinferior and lateral LV
walls (arrows).
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Fig. 1C —19-year-old woman who has had dilated cardiomyopathy
secondary to viral myocarditis since the age of 10 years. Patient experienced
frequent arrhythmias. Late-enhancement short-axis (B) and four-chamber
long-axis (C) images shows mesocardial striae of hyperenhancement
located in basal interventricular septum and posteroinferior and lateral LV
walls (arrows).
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Fig. 2A —60-year-old woman with symmetric hypertrophic cardiomyopathy
who underwent cardiac MRI before surgical intervention for mitral valve
regurgitation and left ventricle (LV) outflow tract obliteration. See also
Figure S2E, cine loop, in supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood two-chamber long-axis image shows diffuse
hypertrophy of left and right ventricle walls (myocardial mass, 307 g)
(arrows).
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Fig. 2B —60-year-old woman with symmetric hypertrophic cardiomyopathy
who underwent cardiac MRI before surgical intervention for mitral valve
regurgitation and left ventricle (LV) outflow tract obliteration. See also
Figure S2E, cine loop, in supplemental data at
www.ajronline.org.
Static cine four-chamber long-axis image shows LV outflow tract obstruction in
systolic phase (arrow).
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Fig. 2C —60-year-old woman with symmetric hypertrophic cardiomyopathy
who underwent cardiac MRI before surgical intervention for mitral valve
regurgitation and left ventricle (LV) outflow tract obliteration. See also
Figure S2E, cine loop, in supplemental data at
www.ajronline.org.
Static cine two-chamber long-axis image shows moderate to severe mitral valve
insufficiency and regurgitant jet (arrow).
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Fig. 2D —60-year-old woman with symmetric hypertrophic cardiomyopathy
who underwent cardiac MRI before surgical intervention for mitral valve
regurgitation and left ventricle (LV) outflow tract obliteration. See also
Figure S2E, cine loop, in supplemental data at
www.ajronline.org.
Analysis of phase-contrast image plot shows altered LV diastolic filling
pattern with early peak–atrial peak ratio < 1.
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Fig. 2E —60-year-old woman with symmetric hypertrophic cardiomyopathy
who underwent cardiac MRI before surgical intervention for mitral valve
regurgitation and left ventricle (LV) outflow tract obliteration. See also
Figure S2E, cine loop, in supplemental data at
www.ajronline.org.
Late-enhancement short-axis image shows diffuse signal hyperintensity after
contrast administration, mainly involving subendocardial and mesocardial
aspects of lateral LV wall (arrows).
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Fig. 3A —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood short-axis images show marked thickening
of interventricular septum and of midbasal aspects of left ventricle (LV)
anterior wall (arrows).
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Fig. 3B —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood short-axis images show marked thickening
of interventricular septum and of midbasal aspects of left ventricle (LV)
anterior wall (arrows).
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Fig. 3C —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Static cine short-axis images in end-diastolic (C) and end-systolic
(D) phases in midventricular plane show hypokinesia of septum and of
midbasal anterior LV wall, where hypertrophy is located (arrows).
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Fig. 3D —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Static cine short-axis images in end-diastolic (C) and end-systolic
(D) phases in midventricular plane show hypokinesia of septum and of
midbasal anterior LV wall, where hypertrophy is located (arrows).
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Fig. 3E —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Late-enhancement short-axis images show diffuse moderate hyperintensity of
midbasal septum (arrows) and two well-evident hyperenhancement foci
in midbasal aspect of anterior and posterior LV walls
(arrowheads).
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Fig. 3F —44-year-old man with asymmetric hypertrophic cardiomyopathy
and chest pain on minor exertion. See also Figure S3G, cine loop, in
supplemental data at
www.ajronline.org.
Late-enhancement short-axis images show diffuse moderate hyperintensity of
midbasal septum (arrows) and two well-evident hyperenhancement foci
in midbasal aspect of anterior and posterior LV walls
(arrowheads).
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Fig. 4A —59-year-old woman with restrictive cardiomyopathy secondary
to hypereosinophilic Löffler's syndrome. Morphologic T2-weighted black
blood two-chamber long-axis image shows apical and posterior left ventricle
(LV) wall thickening (black arrows). Note signal hyperintensity at
apex, occupied by fibrous elastic thrombus (arrowhead). Left atrium
is slightly enlarged (white arrow).
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Fig. 4B —59-year-old woman with restrictive cardiomyopathy secondary
to hypereosinophilic Löffler's syndrome. Static cine two-chamber
long-axis images in end-diastolic (B) and end-systolic (C)
phases show moderate apical hypokinesia (arrows) with preserved LV
systolic function (ejection fraction, 57%). Analysis of phase-contrast images
shows altered LV diastolic filling pattern, with early peak–atrial peak
ratio < 1 and decreased deceleration time.
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Fig. 4C —59-year-old woman with restrictive cardiomyopathy secondary
to hypereosinophilic Löffler's syndrome. Static cine two-chamber
long-axis images in end-diastolic (B) and end-systolic (C)
phases show moderate apical hypokinesia (arrows) with preserved LV
systolic function (ejection fraction, 57%). Analysis of phase-contrast images
shows altered LV diastolic filling pattern, with early peak–atrial peak
ratio < 1 and decreased deceleration time.
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Fig. 4D —59-year-old woman with restrictive cardiomyopathy secondary
to hypereosinophilic Löffler's syndrome. Late-enhancement two-chamber
long-axis image shows subendocardial enhancement at apex, with hypointense
core corresponding to thrombus (arrowhead). Subtle late-enhancement
areas are also seen in posterior wall (arrows).
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Fig. 5A —51-year-old woman who was admitted to coronary unit for
repeated episodes of syncope of unknown origin. Final diagnosis was
arrhythmogenic right ventricular cardiomyopathy. See also Figure S5E and S5F,
cine loops, in supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood short-axis image with fat suppression
shows marked right ventricle enlargement (end-diastolic volume, 325 mL) and
diffuse wall thinning, with hypointense areas of fatty infiltration of
myocardium (arrows).
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Fig. 5B —51-year-old woman who was admitted to coronary unit for
repeated episodes of syncope of unknown origin. Final diagnosis was
arrhythmogenic right ventricular cardiomyopathy. See also Figure S5E and S5F,
cine loops, in supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood four-chamber long-axis image (B)
shows hyperintense areas in apical posterolateral aspect of left ventricle
(straight arrow) and in right ventricle free wall (curved
arrows) that correspond to hypointense foci in fat-suppression image
(C) (straight and curved arrows), due to fatty
infiltration of myocardial wall. In C, thinning of right ventricle free
wall is also evident (arrowhead).
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Fig. 5C —51-year-old woman who was admitted to coronary unit for
repeated episodes of syncope of unknown origin. Final diagnosis was
arrhythmogenic right ventricular cardiomyopathy. See also Figure S5E and S5F,
cine loops, in supplemental data at
www.ajronline.org.
Morphologic T2-weighted black blood four-chamber long-axis image (B)
shows hyperintense areas in apical posterolateral aspect of left ventricle
(straight arrow) and in right ventricle free wall (curved
arrows) that correspond to hypointense foci in fat-suppression image
(C) (straight and curved arrows), due to fatty
infiltration of myocardial wall. In C, thinning of right ventricle free
wall is also evident (arrowhead).
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Fig. 5D —51-year-old woman who was admitted to coronary unit for
repeated episodes of syncope of unknown origin. Final diagnosis was
arrhythmogenic right ventricular cardiomyopathy. See also Figure S5E and S5F,
cine loops, in supplemental data at
www.ajronline.org.
Static cine end-systolic image in four-chamber long-axis plane shows diffuse
and gross bulging in right ventricle outflow tract and free wall
(arrows). Interventricular septal bowing due to abnormal right
ventricle enlargement is also evident (arrowhead).
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Fig. 6A —76-year-old woman with histologic diagnosis of amyloidosis of
periumbilical adipose tissue. Morphologic T2-weighted black blood four-chamber
long-axis image shows symmetric hypertrophy of both left and right ventricles
(arrows). Bilateral pleural effusion is also present
(arrowheads).
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Fig. 6B —76-year-old woman with histologic diagnosis of amyloidosis of
periumbilical adipose tissue. Late-enhancement two-chamber long-axis
(B) and short-axis (C) images show intense subendocardial
enhancement involving all left ventricle walls (arrows).
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Fig. 6C —76-year-old woman with histologic diagnosis of amyloidosis of
periumbilical adipose tissue. Late-enhancement two-chamber long-axis
(B) and short-axis (C) images show intense subendocardial
enhancement involving all left ventricle walls (arrows).
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Fig. 7A —56-year-old woman with pulmonary sarcoidosis. Morphologic
T2-weighted black blood short-axis image with fat suppression shows
hyperintense spot located in posterior aspect of mid left ventricle wall
(arrow) that is caused by myocardial edema and corresponds to subtle
late-enhancement focus described in C (arrow).
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Fig. 7B —56-year-old woman with pulmonary sarcoidosis. Morphologic
T2-weighted black blood STIR four-chamber long-axis image shows small
hyperintense foci in lateral left ventricle wall (arrows) caused by
myocardial edema.
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Fig. 7C —56-year-old woman with pulmonary sarcoidosis.
Late-enhancement short-axis image shows hyperintense focus in posterior aspect
of mid left ventricle wall (arrow) that corresponds to hyperintense
spot described in A.
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Fig. 8A —47-year-old man with Anderson-Fabry disease and arrhythmias.
Morphologic T2-weighted black blood four-chamber long-axis image shows
symmetric hypertrophy of left ventricle (LV) (arrows). Right
ventricle walls also are moderately hypertrophied (arrowhead).
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Fig. 8B —47-year-old man with Anderson-Fabry disease and arrhythmias.
Late-enhancement four-chamber long-axis image shows thick mesocardial
hyperenhancement stria located in midbasal lateral LV wall
(arrows).
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