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Song, Park, Lee, Chung, and Park: Delayed Enhancement Magnetic Resonance Imaging Findings in Cardiac Amyloidosis
Original Article

Journal of the Korean Society of Magnetic Resonance in Medicine 2013; 17(1): 33-40.

Published online: 27 March 2013

DOI: https://doi.org/10.13104/jksmrm.2013.17.1.33

Delayed Enhancement Magnetic Resonance Imaging Findings in Cardiac Amyloidosis

Jin Hwa Song, Eun-Ah Park, Whal Lee, Jin Wook Chung, Jae Hyung Park

Department of Radiology, Seoul National University Hospital, Korea.

Corresponding author: Eun-Ah Park, M.D. Department of Radiology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: 82-2-2072-2584, Fax: 82-2-743-6385, iameuna1@gmail.com

Received 13 April 2012       Revised 27 November 2012       Accepted 27 December 2012

Copyright © 2013 Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Cardiac MR, Delayed enhancement, Cardiac amyloidosis

Figures and Tables

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.
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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.
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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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Table 1
Clinical and Histologic Characteristics of Patients with Cardiac Amyloidosis Showing Delayed Enhancement on CMR
jksmrm-17-33-i001

*Not measured

†Cut-off value of BNP : 100 pg/ml

§Abdominal fat was sampled to histopathologic study

CMR, cardiac magnetic resonance; DE, delayed enhancement; BSA, body surface area; BNP, brain natriuretic peptide; AL, amyloid light chain; TTR, transthyretin; ECG, electrocardiogram; EM, endomyocardium; BM, bone marrow

Table 2
Left Ventricular Enhancement Pattern and Distribution in Patients with Cardiac Amyloidosis
jksmrm-17-33-i002
Table 3
Comparison of Patients with Cardiac Amyloidosis Versus Ischemic Heart Disease
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