ECR 2013 Rec: Cardiomyopathies #A093 #MC422
P. Sipola | Friday, March 8, 08:30 – 10:00 / Room L/M
Cardiac magnetic resonance imaging (CMRI) is highly valuable in the differential diagnosis of cardiomyopathies. MRI diagnosis is based on cine imaging of cardiac function, T2-weighted imaging of oedema and late gadolinium-enhanced (LGE) patterns of scar tissue. Hypertrophic cardiomyopathy (HCM). Left ventricular hypertrophy (LVH) is typically located in basal septum and anterior wall but has variable expression (diffuse, localized). Associated abnormalities include left ventricular (LV) high-ejection fraction (EF), mitral valve abnormalities, apical aneurysm, and right ventricular (RV) hypertrophy. Scattered intramyocardial LGE may occur in various patterns. The differential diagnoses in patient with hypertrophic phenotype include pressure overload hypertrophy, amyloidosis, sarcoidosis, and Fabry’s disease. LGE patterns is useful in differentiation. Dilated cardiomyopathy (DCM): Dilated LV end-systolic volume and impaired EF% are characteristics. Non-ischaemic DCM typically shows no LGE (in contrast to ischaemic cardiomyopthy). Sometimes faint midwall enhancement can be observed, which has prognostic value. Presence of extensive non-compacted myocardium indicates non-compaction cardiomyopathy. Arrhythmogenic right ventricular cardiomyopathy (ARVC): The RV volume is enlargened and akinetic RV segments can be seen. Local bulging or dyskinesia in conjunction with fatty infiltration and LGE is typical. Restricted cardiomyopathy (RCM): Enlargened atrias and normal sized ventricles with preserved EF% and no LGE are characteristics. Myocarditis: LV systolic function is typically lowered but may be normal. T2 images may show increased signal. LGE limited to the subepicardial myocardium is highly suggestive of myocarditis. Iron overload cardiomyopathy: Cine imaging is used to assess LV global function and T2*-weighted imaging to quantitate ventricular iron deposition.