What is remarkable regarding the measured native T1 and calculated extracellular volume (ECV) values in this case?
The increase in native T1 and especially the calculated extracellular volume (ECV) are massive. The whole myocardium is affected.
Cine images, T2 black-blood and STIR imaging:
Thickening of the interventricular septum (orange measurement >20mm) and the interatrial septum (blue measurement ≈ 8mm).
T2 ratio was <1.9 – a T2 ratio of ≥2 is considered abnormal.
Minimal pericardial effusion (blue arrowhead).
Look-Locker:
Images sorted by acquisition time.
On close inspection, the myocardium passes through the zero-point before the blood pool. Usually, this is the other way around.
Late gadolinium enhancement (LGE):
It is conspicuous, that the blood pool has an even darker signal than the "nulled" myocardium not only on the inversion recovery gradient echo images but also on the PSIR image. This is due to high myocardial gadolinium uptake and fast blood washout referred to as abnormal blood-pool gadolinium kinetics 1.
There is subendocardial late gadolinium enhancement in a non-coronary arterial distribution (red arrowheads) in midventricular and basal segments, and faint transmural enhancement of the septal and inferior basal segments (red arrows).
T1 mapping native and postcontrast:
Obviously increased native T1 here measured in the basal inferoseptal segment (z-score of 6.3). Native T1 measured in other segments ranged from 1170-1250 ms.
Decreased postcontrast T1.
Massively increased calculated extracellular volume (ECV) by ≥60%.