Delayed myocardial enhancement, as seen on cardiac MRI, occurs when gadolinium contrast material seeps into fibrotic or necrotic myocardial tissue. It is due to a number of aetiologies, and has variable appearances.
- subendocardial enhancement indicates an ischaemic aetiology
- transmural enhancement is nonspecific, but suggestive of an ischaemic aetiology
- mid-wall enhancement indicates a non-ischaemic etiology (e.g. myocarditis, idiopathic dilated cardiomyopathy)
- diffuse patchy areas of enhancement are seen in cardiac amyloidosis