Interpretation of cardiac magnetic resonance imaging of left ventricular hypertrophy: a practical guide

Figures

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  Figure 1. Hypertensive heart disease showing mild left ventricular myocardial hypertrophy and cavitary dilatation. A) Linear late gadolinium enhancement (LGE) is observed in the interventricular septum and inferior wall at the midventricular level (arrows). B) Endomyocardial biopsy reveals myocyte enlargement with slight fibrosis (hematoxylin and eosin staining). Myocardial disarray is not found. C) The left ventricular cavity regresses following anti-hypertensive treatments, whereas LGE remains (arrows)

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  Figure 2. Typical cine images of hypertrophic cardiomyopathy. A) Basal septal hypertrophy is observed at the end-diastolic phase, which evokes obstruction of the left ventricular outflow tract (arrow). B) Cine images at end-systole showing a midventricular obstruction (arrowhead) with an apical aneurysm (arrow). C) Apical hypertrophy is found at the end-diastolic phase (arrows)

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  Figure 3. T2-weighted imaging reveals high intensity at the hypertrophied septum, which is related to unexpected syncope in this patient (arrows). The papillary muscle is also hypertrophied (arrowhead). B) Late gadolinium enhancement reveals typical myocardial scarring at the insertion point of both ventricles (arrows)

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  Figure 4. A) In midventricular obstructive hypertrophic cardiomyopathy (MVO HCM), transmural late gadolinium enhancement is observed at the apical aneurysm with a thin myocardial wall (arrow). B) Masson trichrome staining reveals marked replacement fibrosis at the resected apical aneurysm in another patient with MVO HCM

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  Figure 5. Jet flow void is observed at the early systolic phase in a patient with aortic stenosis (arrow). Septal hypertrophy is found in this patient (arrowhead)

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  Figure 6. A) Cardiac amyloidosis shows diffuse late gadolinium enhancement. B) The postcontrast T1 value of the septal myocardium at 300 ms is close to the blood T1 value of 290 ms. The extracellular volume fraction is markedly elevated at 51.9% (> 28.0%, the upper limit of the reference value). C) Direct fast scarlet staining reveals diffuse distribution of amyloid fibrils (bright brown)

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  Figure 7. A) Anderson-Fabry disease reveals a T1 value of 870 ms, which is significantly shorter than the lower limit of normal T1 value (i.e., 950 ms). B) Late gadolinium enhancement reveals typical myocardial scarring at the basal lateral myocardium (arrow)

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  Figure 8. Mitochondrial myopathy shows intramural, patchy late gadolinium enhancement in the inferolateral myocardium at the basal level (arrow)

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  Figure 9. Glycogen storage disease type III shows patchy late gadolinium enhancement in the markedly hypertrophied septum (arrow)

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  Figure 10. Noonan syndrome shows marked hypertrophy of the anterior and septal myocardium. Subtle late gadolinium enhancement is observed in the anterior wall (arrows)

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  Figure 11. A) Chronic kidney disease exhibits an increased T1 of 1127 ms (> 1110 ms, the upper limit of the reference value) and B) T2 of 55 ms (> 51 ms, the upper limit of the reference). C) An autopsy of another patient with CKD reveals marked fibrosis intervening in the myocardial layers (Masson trichrome staining)