Cardiovascular Magnetic Resonance Imaging Patterns in Rare Cardiovascular Diseases

Abstract

Rare cardiovascular diseases (RCDs) have low incidence but major clinical impact. RCDs' classification includes Class I-systemic circulation, Class II-pulmonary circulation, Class III-cardiomyopathies, Class IV-congenital cardiovascular diseases (CVD), Class V-cardiac tumors and CVD in malignancy, Class VI-cardiac arrhythmogenic disorders, Class VII-CVD in pregnancy, Class VIII-unclassified rare CVD. Cardiovascular Magnetic Resonance (CMR) is useful in the diagnosis/management of RCDs, as it performs angiography, function, perfusion, and tissue characterization in the same examination. Edema expressed as a high signal in STIRT2 or increased T2 mapping is common in acute/active inflammatory states. Diffuse subendocardial fibrosis, expressed as diffuse late gadolinium enhancement (LGE), is characteristic of microvascular disease as in systemic sclerosis, small vessel vasculitis, cardiac amyloidosis, and metabolic disorders. Replacement fibrosis, expressed as LGE, in the inferolateral wall of the left ventricle (LV) is typical of neuromuscular disorders. Patchy LGE with concurrent edema is typical of myocarditis, irrespective of the cause. Cardiac hypertrophy is characteristic in hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA) and Anderson-Fabry Disease (AFD), but LGE is located in the IVS, subendocardium and lateral wall in HCM, CA and AFD, respectively. Native T1 mapping is increased in HCM and CA and reduced in AFD. Magnetic resonance angiography provides information on aortopathies, such as Marfan, Turner syndrome and Takayasu vasculitis. LGE in the right ventricle is the typical finding of ARVC, but it may involve LV, leading to the diagnosis of arrhythmogenic cardiomyopathy. Tissue changes in RCDs may be detected only through parametric imaging indices.

Keywords: CMR; MRI; cardiac; cardiovascular; cardiovascular magnetic resonance; heart; imaging; magnetic resonance imaging; rare cardiovascular disease; rare disease.

Figure 1

(A) Short-axis LGE image showing myocardial infarction (arrows) in the inferolateral wall of LV. (B) Matching native T1 mapping of the same patient.

Figure 2

MRA of a patient with Takayasu disease showing left (L) subclavian artery stenosis (arrow).

Figure 3

Short axis LGE image showing diffuse subendocardial fibrosis (arrows) in a patient with Churg–Strauss vasculitis.

Figure 4

Four chamber inversion recovery image showing severe hypertrophy and extensive LGE (arrows).

Figure 5

(A) Short axis LGE image showing diffuse amyloidosis (arrows). (B) Matching native T1 mapping of the same patient.

Figure 6

Four chamber inversion recovery image showing the presence of fibroma (arrows) in left atrium.

Figure 7

Four chamber T1 mapping showing LV infiltration and RV-Right atrium masses (arrows) due to melanoma.