Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes

Figures

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  Figure 1. Post-contrast short-axis imaging of a healthy 25-year-old male competitive athlete with isolated RVIP fibrosis (dotted red circle) in the context of an otherwise normal CMR.

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  Figure 2. Left: short-axis (A) and 4-chambers long-axis (B) SSFP-images of a 27-year-old male competitive athlete with borderline LV symmetrical hypertrophy (13 mm, white arrows) in the context of mildly increased biventricular volumes and normal biventricular function and no other symptoms or signs of disease. Right: short-axis (C) and 4-chambers long-axis (D) SSFP-images of a 32-year-old male athlete with increased LV wall thickness especially on interventricular septum (15 mm, yellow arrows), relatively small LV cavity obliterating in systole, papillary muscle hypertrophy (orange asterisk); sequences have been acquired after gadolinium injection and inhomogeneous myocardial signal can be appreciated in these images (orange arrows). The athlete had been referred to CMR for ECG abnormalities.

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  Figure 3. (A,B): post-contrast imaging (apical 4-chambers view and mid short-axis view) of a 32-year-old male athlete with a diagnosis of HCM with diffuse areas of patchy non-ischemic LGE (green asterisks). (C): short-axis view post-contrast imaging of a 41-year-old female ex-athlete with HCM showing areas of LGE in the basal anteroseptal segment and inferior RVIP (green arrows).

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  Figure 4. (A–D): 28-year-old male endurance athlete; SSFP cine sequences (A,C): diastolic frames show mild LV dilatation with harmonic dilatation of the other cardiac chambers and preserved systolic function (B,D): systolic frames. (E,F): SSFP sequences of a 34-year-old male patient with DCM; LV is severely dilated, spherical and moderately dysfunctional (E,G: diastolic frames, F,H: systolic frames).

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  Figure 5. LGE short-axis sequences of a 28-year-old male endurance athlete with athlete’s hearts (A) and of a 34-year-old male patient with DCM (B). In the first case, mild LGE signal is seen in the inferior RVIP (red arrow). In (B), a thin LGE stria can be appreciated in the interventricular (IV) septum (white arrows), and a more pronounced LGE storage is visible in the anterior and inferior RVIP (yellow arrows).

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  Figure 6. SSFP cine CMR sequences of a 33-year-old female ex-athlete with arrhythmogenic right ventricular cardiomyopathy. RV dilatation and dysfunction can be appreciated through diastolic and systolic frames ((A1,A2) for 4-chamber view, (B1,B2) for short-axis view, (C1,C2) for RV vertical long-axis view, respectively), as well as wall motion abnormalities (white dotted lines).

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  Figure 7. 43-year-old patient with biventricular ACM. T1-weighted sequences (A), 4-chambers view, and (B), short-axis view) show mild signs of fatty infiltration (green arrows). Post-contrast sequences (C), short-axis view, and (D), right heart 2-chambers view) reveal non-ischemic LGE involving both RV and LV walls (red arrows).

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  Figure 8. 39-year-old male football player with uncommon ventricular arrhythmias. No systolic dysfunction or wall motion abnormalities are seen on SSFP cine-sequences (A,B): diastolic and systolic frames of 3-chambers view; (C,D): diastolic and systolic frames of short-axis view. (E,F): post-contrast imaging shows a sub-epicardial stria of LGE involving the basal and middle portion of infero-lateral LV wall (red dotted lines).

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  Figure 9. (A–C): 19-year-old healthy male runner with hypertrabeculation of LV in the context of an otherwise normal CMR. (D–F): 23-year-old male athlete with a diagnosis of LVNC (later confirmed with genetic testing) with evidence of non-ischemic LGE on post-contrast imaging (blue dotted line).

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  Figure 10. 54-year-old recreational athlete with anomalous circumflex artery (CX) running behind the aorta (#). The CX (orange arrow) originates from the right coronary artery (blue arrow) and has a retroaortic course.

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  Figure 11. 36-year-old pentathlete with anomalous right coronary artery (RCA). Dominant RCA (orange arrow) originates from the left sinus Valsalva and runs between the aorta (#) and the truncus pulmonalis (*).

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  Figure 12. Healthy volunteer is preparing for the stress CMR test.