N Engl J Med 2004; 350:1320-1327, Hansen MW, Merchant N. MRI of hypertrophic cardiomyopathy: part 1, MRI appearances. Administration of Gadolinium results in uptake of the contrast agent into both normal and injured myocardium. In nonischemic cardiomyopathy, myocardial scar may be present in multiple coronary territories. In normal myocardium there will be early wash out of contrast. The motion abnormalities are transient and return to normal within weeks. The late enhancement image does not show any enhancement. On the left a 4-chamber view of a patient with idiopathic cardiomyopathy. Notice the diastolic septal bounce which is typical for constrictive cardiomyopathy. Myocardial segments with abnormal enhancement or wall motion disturbances are named and localized according to the 17 segments model of the American Heart Association (37). Both 1.5- and 3-T MRI scanning produce good image quality on modern scanners. Cardiac Imaging: Part 1, MR Pulse Sequences, Imaging Planes, and Basic Anatomy, Review. The tag lines deform with the myocardium as it contracts or relaxes, allowing precise determination of myocardial contraction patterns Because several experimental medical treatments are now being studied for HCM, MRI will be used in future clinical trials to determine if subtle improvements in regional contraction or relaxation may occur after therapy. ARVC (3) Abnormal laboratory findings and ECG changes may also suggest an acute coronary syndrome. A multidisciplinary team that is expert in understanding the manifestations of ARVD is helpful to avoid a false-positive MRI diagnosis . There are two compelling reasons these somewhat unusual diseases focus our attention for cardiac MRI. There is currently an extraordinary research effort aimed at risk prediction and localized treatment on the basis of cardiac MRI evaluation of myocardial scar. Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture. In chronic infarctions the late enhancement is a result of retention of contrast material in the large interstitial space between the collagen fibers in the fibrotic tissue . The myocardium has a very limited response to cellular injury and can be replaced by either fibrosis or fat tissue. Notice the dilated right ventricle with severe segmental dyskinesis resulting in small aneurysms. Histologically, HCM shows myocardial disarray and collagen deposition, eventually resulting in a thickened, poorly contracting myocardium. Cardiac amyloidosis shows enhancement that is frequently subendocardial but in a noncoronary distribution and may involve all four cardiac chambers as well as valvular enhancement. The differentiation between idiopathic dilated cardiomyopathy and ischemic dilated cardiomyopathy is important, as ischemic cardiomyopathy might be treated with revascularization and idiopathic disease not. As discussed, it appears that 6–12% of these individuals will have abnormal morphology at MRI. Keywords: arrhythmogenic right ventricular dysplasia, cardiomyopathy, hypertrophic cardiomyopathy, MRI, myocardium. More advanced disease is accompanied myriad abnormalities, including right ventricular enlargement, delayed gadolinium enhancement, and fatty infiltration. Dilated cardiomyopathy (3) Late enhancement image shows enhancement over the entire subendocardial circumference, variably extending into the neighboring myocardium . The ejection fraction was measured to be 28%. The detection of myocardial fibrosis (or scar) is well known from the evaluation of myocardial infarction with delayed enhanced MRI of the heart. Notice the midmyocardial enhancement of the lateral wall. Although the first line of therapy for ischemic cardiomyopathy is directed at improving myocardial blood flow in narrowed coronary arteries (e.g., using coronary stents or bypass surgery), such therapy usually has no role in patients with nonischemic cardiomyopathy. European Heart Journal 2005 26(15):1461-1474, A Statement for Healthcare Professionals From the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association et al Radiographics 2006; 26:795-810, White JA, Patel MR. The role of cardiovascular MRI in heart failure and the cardiomyopathies. N Engl J Med 2000; 343:1445-1453, Maron BJ, Towbin JA, Thiene G, et al. OBJECTIVE. Acute myocarditis can be a cause of sudden cardiac death. Circulation 2006; 113:1807-1816, Elliott P, Andersson B, Arbustini E, et al. Dilated Cardiomyopathy – it occurs due to progressive cardiac dilatation with concomitant hypertrophy. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. Patients with idiopathic dilated cardiomyopathy show either no enhancement or linear midmyocardial enhancement . 1-ranked heart program in the United States. On an end-systolic image the following findings can be depicted (figure): HOCM (2) Fatty infiltration of the left ventricle may also be present. Disease of the myocardium associated with atherosclerosis is termed “ischemic” cardiomyopathy. Early in their disease course, tissue Doppler echocardiography has shown that diastolic function is abnormal despite normal wall thickness. In acute infarctions the contrast enters the damaged myocardial cells due to myocyte membrane disruption. These diseases are classified as nonischemic cardiomyopathy.  showed that the presence or absence of delayed enhancement at MRI was the primary predictor of nonsustained ventricular tachycardia. 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