What is conspicuous, viewing the IRGE and PSIR images?
The blood pool has a dark signal similar to the myocardium. There is a subendocardial late gadolinium enhancement in a non-coronary arterial distribution, together with transmural enhancement of the basal and midventricular segments.
What is conspicuous about the look locker sequence?
The myocardium passes through the zero-point before the blood pool.
Which cardiac pathologies can lead to increased native T1 and ECV values?
Many, including amyloidosis, myocarditis, myocardial infarction, Tako-tsubo cardiomyopathy and anything which can lead to fibrosis.
Findings:
Heart rate: 68 bpm, body surface area (BSA) 2.03 m²
Haematocrit: 0.39
Image quality: no limitations
Morphology and functional analysis:
- LV-EDVI: 91 mL/m²
- LV-ESVI: 49 mL/m²
- LV-SVI: 42 mL/m²
- LV-EF: 46%
- cardiac output: 6.3 L/min
- cardiac index: 3.1 L/min/m²
- LV-ED wall + papillary mass index: 151 g/m²
- Septum thickness: 20 mm
Global hypokinesia, pronounced in the thickened basal inferoseptal and inferior segments.
Mildly increased left atrium. Thickened atrial septum. Persistent foramen ovale (PFO).
Aortic valve insufficiency with a diastolic jet in the left ventricular outflow tract (LVOT).
No intracavitary thrombi were found.
Myocardial tissue properties
Increased myocardial signal intensity in the apical segments, probably due to stagnant blood.
Difficulties in nulling the myocardium with the look locker sequence.
PSIR and IR-GE sequences show a dark blood pool and a subendocardial late gadolinium enhancement in a non-coronary arterial distribution with a lesser extent in the apical segments, together with a transmural enhancement of the basal segments.
T1 mapping native: 1170-1250 ms [950-1060ms*], extracellular volume (ECV): ≥60%
*reference range based on local data
No pericardial enhancement. Minimal pericardial effusion.
Impression:
Non-obstructive left ventricular hypertrophy with mild systolic dysfunction.
Cardiac MRI findings are consistent with cardiac amyloidosis.
The high values in extracellular volume (ECV) and the distinct thickening of the interventricular septum favour ATTR over AL cardiac amyloidosis.