1. Rodney H. Falk et al. JACC 2016;68:1323-1341
Use of MR for Diagnosis of Cardiac Amyloidosis and Estimate of Myocardial Amyloid Burden (Top panel) Images from a modified Look-Locker acquisition in a patient with TTR cardiac amyloidosis, shown here in the order of increasing times after the magnetization inversion (TI). The images were acquired approximately 25 min after injection of 0.2 mmol/kg of gadolinium contrast, and the T1 in myocardium averaged 490 and 597 ms in the blood pool. The myocardial signal nulls characteristically early compared with the blood pool signal. (Bottom left panel) A bull’s-eye plot of extracellular volume (ECV) fraction in the same patient, calculated from pre- and post-contrast relaxation rate measurements for each of 6 myocardial segments in basal, mid, and apical slice locations, respectively. (Bottom right panel) Images of late gadolinium enhancement (LGE) in a 2-chamber view for the same patient. Although ECV values in this patient approach the range measured for ECV in myocardial infarcts, the LGE image shows more muted enhancement than is seen for myocardial infarctions, which reflects the diffuse and global effect of cardiac amyloidosis in comparison to LGE in myocardial infarctions. LGE may therefore underestimate the severity of disease, whereas ECV provides an objective measure of extracellular space expansion. Other abbreviations as in Figure 1.
Rodney H. Falk et al. JACC 2016;68:
American College of Cardiology Foundation