Magnetic resonance imaging in hypertrophied left ventricular myocardium due to amyloidosis

Abstract

The certain diagnosis of cardiac amyloidosis is only possible with myocardial biopsy, even if echocardiographic studies often show a typical sparkling pattern. Using magnetic resonance imaging (MRI) we examined if there is a specific morphological pattern in patients with amyloidosis compared with patients with hypertrophic cardiomyopathy (LVH). With a 1.0 T magnetom and FISP 2D sequences two patients with biopsy-proven cardiac amyloidosis (AL), two patients with generalized AL and suspected cardiac AL, and five patients with LVH were examined and data were compared with echocardiography. In two cases with cardiac AL, contrast medium (Gd-DTPA) was given and dynamic-turbo-flash-sequences were obtained. In patients with AL, both ventricles were hypertrophied, whereas in the cases of hypertrophy due to other reasons only the left ventricle was hypertrophied. The systolic wall thickening was in all cases of amyloidosis below 30%. In contrast to echocardiography, a myocardial sparkling pattern in amyloidosis was not found with MRI. Even with additional contrast examination we could not differentiate the types of hypertrophy by imaging solely the left ventricular wall. There is no specific myocardial pattern in cardiac amyloidosis neither in standard MRI nor after examination with additional contrast medium, but concomitant right ventricular (RV) and left ventricular (LV) hypertrophy is a typical observation in these patients.