Magnetic Resonance Imaging Applications on Infiltrative Cardiomyopathies

Abstract

Infiltrative cardiomyopathies are a heterogenous group of diseases that typically lead to restrictive cardiac dysfunction. Due to similar phenotypes, accurate diagnosis is challenging without invasive endomyocardial biopsy which has historically been considered mandatory. Cardiac magnetic resonance (CMR) has been well established in the diagnostic workup of patients with suspected cardiomyopathies due to its unique capability for tissue differentiation and its unsurpassed accuracy in defining cardiac morphology and function. The increasing variety of CMR techniques has generated both excitement and uncertainty with regard to their potential clinical use and its role vis-à-vis conventional noninvasive imaging techniques. The purpose of this review is to give an overview of established and emerging CMR techniques and typical image characteristics of the most commonly encountered infiltrative cardiomyopathies.

The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update

“…Nearly one-third of restrictive cardiomyopathy cases have delayed myocardial enhancement due to inflammation and associated fibrosis [80]. At the same time, contrast-enhanced T1 mapping can be used to better quantify myocardial fibrosis and delayed enhanced inversion recovery imaging to identify different types of infiltrative cardiomyopathies [81]. Sometimes, as in AL amyloidosis, delayed gadolinium enhancement may have prognostic value along with serum biomarkers, while T1 has shown greater sensitivity than gadolinium in the early detection of amyloid deposits [82].…”

Cardiovascular magnetic resonance (CMR) in restrictive cardiomyopathies

“…In case of suspected RCM, CMR protocol should encompass cine steady-state free precession (SSFP) electrocardiography-gated sequences to assess atrial and ventricular volumes, wall motion anomalies and morphologic abnormalities such as atrial enlargement or LV wall thickening [ 3 ].…”

ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure

“…Cardiac MRI remains heavily reliant on electrocardiographic referencing of imaging data acquisition to the cardiac cycle and uses a magnetic field and radio waves to create detailed tomographic or volumetric images of high contrast. Depending upon the imaging acquisition employed and whether or not a gadolinium-based contrast agent was used and how and when administered relative to data acquisition, images demonstrating a range of abnormalities of (1) anatomy (eg, reduced thickness of ventricular wall, enlargement of atrial cavity, or increased thickness of pericardial sac); (2) histology (eg, myocardial edema, infiltration, deposition, or fibrosis); or (3) physiology (eg, depressed LVEF, restrictive transatrioventricular diastolic inflow, or reduced resting versus stress-induced myocardial strain or first-pass perfusion) [26][27][28]. These capabilities are potentially beneficial in assessing HF.…”