Differential diagnosis of thickened myocardium: an illustrative MRI review

Figures

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  Fig. 1. A 20-year-old competitive runner man with athlete’s heart. a Short-axis and (b) three-chamber steady-state free precession (SSFP) MR images at end-diastole. The left ventricle is enlarged and (end-diastolic diameter = 58 mm) and basal septal thickness is 15 mm. c Post-contrast T1-weighted inversion recovery gradient echo image shows normal myocardial signal intensity (asterisks)

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  Fig. 2. A 64-year-old woman with essential hypertension treated for several years. a Three-chamber cine SSFP MR image at end-diastole showing asymmetrical basal septal myocardial hypertrophy (asterisk). b Four-chamber view of LGE image shows normal dark myocardial signal intensity. Left atrial enlargement also can be seen

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  Fig. 3. a Three-chamber view at end-systole of a 53-year-old man with dyspnea at rest and aortic valve stenosis. b Three-chamber view at early systole in a 45-year-old woman with obstructive hypertrophic cardiomyopathy. Jet of turbulent flow is seen exactly across the aortic valve in aortic valve stenosis (arrowheads) and in the subaortic region (arrows) in obstructive hypertrophic cardiomyopathy with anterior displacement (arrowhead) of an elongated anterior mitral leaflet

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  Fig. 4. A 65-year-old man with cardiac amyloidosis. a Short-axis, (b) four-chamber and (c) three-chamber cine SSFP MR images at end-diastole show diffuse asymmetric myocardial thickening, of both, LV and RV, thickening of left atrial wall (arrows) and interatrial septum (arrowheads) and pericardial effusion (asterisks). d Short-axis and (e) two-chamber LGE images showing transmural atrial wall enhancement (arrowheads) and diffuse myocardial enhancement sparing the mid-wall of ventricular septum (arrow)

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  Fig. 5. A 75-year-old man with cardiac amyloidosis. a Sequential inversion recovery T1-weighted gradient echo images with a variable inversion time trying to null normal myocardium show the difficult to determine the optimal inversion time to null myocardium. The blood pool and the myocardial nulling occurs earlier at 225 ms than the splenic nulling (275 ms). b Short-axis T1-weighted inversion recovery gradient echo images obtained at (b) 4 minutes and (c) 8 minutes after the injection of contrast agent. The myocardium displays predominantly subendocardial LGE at 4 minutes, but it is diffusely enhanced at 8 minutes

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  Fig. 6. A 29-year-old man with pulmonary sarcoidosis who had recurrent ventricular tachycardia and negative coronary angiography findings. a Short-axis and (b) axial cine SSFP MR images at end-diastole show basal septal myocardial thickening (asterisks). c Short-axis post contrast T1-weighted inversion recovery gradient echo image shows subepicardial LGE (arrows) in the inferoseptal and inferior walls of the left ventricle, as well as subendocardial LGE (arrowheads) in the inferior wall of the right ventricle. Functional assessment (not shown) demonstrated 35% left ventricular ejection fraction

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  Fig. 7. A 45-year-old woman with reduced ejection fraction and isolated LV non-compaction. a Echocardiographic findings were suggestive of apical hypertrophic cardiomyopathy (asterisks). b Short-axis cine SSFP MR image at end-diastole shows left ventricular apical trabeculated myocardium and thin epicardial compacted layer. End-diastolic ratio between non-compacted and compacted layers is greater than 2.3. c End-diastolic long-axis view SSFP image demonstrates the myocardial trabeculations (arrows) and clearly depicts their extension from apex to lateral wall

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  Fig. 8. A 22-year-old woman with endomyocardial fibrosis. End-diastolic four-chamber cine SSFP MR image shows right ventricular apical thickening (arrow) and marked right atrial dilatation (asterisk) with signal void attributed to turbulent blood flow

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  Fig. 9. A 39-year-old woman with endomyocardial fibrosis. a Four-chamber view cine SSFP MR image at end-diastole shows right atrial dilatation and myocardial thickening (asterisk) with obliteration of the right ventricular apical chamber. b Non-enhanced thoracic CT scan showing endocardial calcification (arrowheads)