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Int J Angiol 2022; 31(01): 040-047
DOI: 10.1055/s-0041-1735948
Original Article

Magnetic Resonance Imaging in Cardiac Amyloidosis: Unraveling the Stealth Entity

Omair Shah 
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Naseer Choh
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Tahleel Shera
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Faiz Shera
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Tariq Gojwari
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Feroze Shaheen
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
,
Irfan Robbani
1   Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Jammu and Kashmir, India
› Author Affiliations Funding None.
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Abstract

Amyloidosis is a systemic disease involving many organs. Cardiac involvement is a significant cause of morbidity and mortality in these patients. Diagnosis of cardiac amyloidosis is based on endomyocardial biopsy which however is invasive and associated with complications. Noninvasive methods of diagnosis include magnetic resonance imaging (MRI) with various methods and sequences involved. Our study aims at describing MRI features of cardiac amyloidosis including new imaging sequences and to prognosticate the patients based on imaging features. We included 35 patients with suspected cardiac amyloidosis who underwent MRI at our center over 4 years. All images were retrieved from our archive and assessed by an experienced radiologist. Common morphological features in our patients included increased wall thickness of left ventricle (LV) (16. 1 ± 4.1 mm), right ventricle (RV) (6.3 ± 1.1 mm), and interatrial septum (6.2 ± 0.8 mm). Global late gadolinium enhancement (LGE) (n = 21 [65%]) including subendocardial or transmural was the most common pattern followed by patchy enhancement. Global transmural LGE was associated with worse prognosis. Four types of myocardial nulling patterns were observed on postcontrast time to invert (TI) scout imaging: normal nulling pattern (myocardium nulls after blood and coincident with spleen) and abnormal nulling pattern (ANP) which is further divided into three types: Type 1—myocardium nulls before blood pool but coincident with spleen, Type 2—myocardium nulling coincident with blood but not coincident with spleen, and Type 3—features of both Type 1 and Type 2. Type 3 ANP was the most common (n = 23) nulling pattern in our patients. Cardiac MRI is an essential in noninvasive diagnosis of cardiac amyloidosis. Transmural global LGE serves as a poor prognosticator in these patients. “Three-tier” TI scout imaging is essential to avoid false-negative enhancement results. Type 3 ANP is the most specific nulling pattern in cardiac amyloidosis.

Keywords

abnormal nulling pattern - balanced single shot free precession - time to invert - magnetic resonance imaging - echocardiography

Ethics Approval and Consent to Participate

Our study was an observational study with no requirement for ethical clearance in our institution. The consent from the patients was however taken in all the cases.


Authors' Contribution

O.S.: Study design, data collection, statistical analysis, data interpretation, manuscript preparation, and literature search.


N.C.: Study design, data collection, data interpretation, and literature search.


T.S: Study design, data interpretation, and manuscript preparation.


F.S.: Data collection, statistical analysis, and manuscript preparation


T.G.: Study design, statistical analysis, and data interpretation.


F.S.: Data collection, data interpretation, and manuscript preparation.


I.R.: Study design.


Data Interpretation

All authors have read and approved the manuscript.




Publication History

Article published online:
21 September 2021

© 2021. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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