PMC5245855_01
MRI axial images of the heart using different pulse sequences to demonstrate
myocardial segment of fatty infiltration in the LV apex. The CMR protocol
included T1-weighted spin-echo (with-and-without fat-suppression),
T2-weighted black-blood image, and DHE after administration of gadolinium.
(A) T2-weighted black blood; (B) T1-weighted turbo spin echo; (C)
T1-weighted turbo spin echo with fat saturation (showed clear nulling of
apical fatty area); (D) DHE technique showing no evidence of myocardial
scar; (E) Multi-detector CT image that shows a focal area of fatty
infiltration in the LV apex (black arrow). This area has a negative
Hounsfield value indicating its fatty nature. Follow-up 3 Tesla CMR study
after 18 months showed no significant changes in fat distribution within LV;
(F) Two-chamber T1-weighted turbo spin echo showing the fatty area at the LV
apex; (G) Two-chamber T1-weighted turbo spin echo with fat saturation
showing clear nulling of apical fatty area; (H) Axial T1-weighted
single-shot axial image of the most distal apical portion of LV showing part
of the fatty area; (I) DHE technique showing no evidence of myocardial scar;
however, the fatty area is not enhanced.
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A focal area of fatty infiltration was seen in the left ventricular (LV) apex extending from the subendocardial to the subepicardial surfaces (Figure 1A and 1B). This area was suppressed with fat saturation pulse-sequences (Figure 1C), and did not show enhanced signal on delayed-hyperenhancement images (DHE) (Figure 1D). The fatty area was also seen retrospectively on the cardiac CT (Figure 1E).