Cardiac amyloidosis MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Aarti Narayan, M.B.B.S [3]

Overview

Amyloidosis is an infiltrative disease resulting in deposition of amyloid in the extracellular spaces of the tissues. Amyloid infiltration of the heart leads to expansion of these extracellular spaces resulting in retainment of gadolinium dye during cardiac magnetic resonance imaging. This retainment of gadolinium leads to signal enhancement in the late washout phase during delayed enhanced cardiac imaging.

Cardiac MRI

CMR findings in cardiac amyloidosis include:

• Global subendocardial signal enhancement in the late washout phase (late gadolinium enhancement [LGE]) during delayed enhanced imaging. This finding is strongly suggestive of cardiac amyloid as it is rarely seen in other cardiomyopathies.
• Increased gadolinium wash-out time
• Abnormal myocardial and blood-pool gadolinium kinetics
• Brighter appearance of the myocardium compared to normal myocardium

CMR has a sensitivity of 88% and a specificity of 95% in the diagnosis and is considered the most accurate predictor of biopsy positive cardiac amyloidosis.

Advantages

• More sensitive than echo as LGE can be present in patients with amyloidosis with normal ventricular wall thickness also.

Dis-advantages

• Caution should be maintained in patients with renal failure.

ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance (DO NOT EDIT)

“

CMR may be used for assessment of patients with LV dysfunction or hypertrophy or suspected forms of cardiac injury not related to ischemic heart disease. When the diagnosis is unclear, CMR may be considered to identify the etiology of cardiac dysfunction in patients presenting with heart failure, including Evaluation of dilated cardiomyopathy in the setting of normal coronary arteries Patients with positive cardiac enzymes without obstructive atherosclerosis on angiography Patients suspected of amyloidosis or other infiltrative diseases Hypertrophic cardiomyopathy Arrhythmogenic right ventricular dysplasia Syncope or ventricular arrhythmia

”

Images

MRI showing cardiac amyloidosis (yellow arrow).

MRI showing concentric ventricular remodelling (white arrows) secondary to amyloid deposition.

References

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