Cardiac MRI in restrictive cardiomyopathy

(a) Restrictive cardiomyopathy. SSFP image in four-chamber view shows typical imaging features: normal-sized ventricles with smooth outline, dilatation of both atria, and normal thickness of the pericardium. A small pericardial effusion is also present. (b) Constrictive pericarditis. SSFP image in four-chamber view shows typical imaging features: normal-sized ventricles, bi-atrial dilatation, but with indentation upon the right atrio-ventricular groove and right ventricle due to thickened pericardium (arrow). The profound hypointensity of pericardium in this location is due to calcification. There are bilateral pleural effusions.

Amyloidosis. (a) Fast spin-echo, T1-weighted image in four-chamber view reveals thickening of the myocardium of both ventricles and bi-atrial dilatation. Arrow points to thickening of the inter-atrial septum (9 mm), characteristic of the condition. (b) Delayed enhanced (phase-sensitive inversion recovery; PSIR) image in four-chamber view in another patient shows global transmural enhancement of the left ventricular myocardium. Note also the enhancement of the inter-atrial septum and right atrial wall.

Sarcoidosis. (a) Fast spin-echo, T2-weighted image (fat suppressed) in the axial plane shows hyperintense areas in the interventricular septum (IVS) and lateral wall of left ventricle (LV) (arrows), probably suggesting acute inflammatory changes. (b) Delayed, enhanced (PSIR) image in four-chamber view in a different case revealing multiple, discrete, enhancing lesions along the IVS, apex and lateral wall of the LV. Some of these are linear while others are rounded foci, probably reflecting a combination of persistent inflammation and fibrosis.

Endomyocardial fibrosis. (a) Delayed, enhanced (PSIR) image in four-chamber view shows the characteristic three-layered appearance of this disease at the apex of the LV. The innermost layer is the enhancing peripheral layer of the thrombus (black arrowhead), the middle represents the thrombus core, and the outermost layer represents the enhancing subendocardium (arrows). Additionally, there is subendocardial enhancement along the right ventricular apex (white arrowhead). (b) Fast spin-echo, T1-weighted image in four-chamber view in another patient showing typical bi-ventricular apical obliteration.

Iron-overload cardiomyopathy. (a) This short axis image shows a bright-blood T2∗ sequence from a transfusion-dependent patient with thalassaemia. The myocardium is initially bright (arrows) but the signal decays rapidly due to the high level of myocardial iron. (b) In the same patient the T2∗ value is 9.4 ms, which represents severe iron overload.