Related Experiment Video
Updated: Aug 17, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Delayed contrast enhancement and perfusable tissue index in hypertrophic cardiomyopathy: comparison between cardiac
Paul Knaapen1, Willem G van Dockum, Olga Bondarenko
1Department of Cardiology, 6D 120 VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. p.knaapen@vumc.nl
Unlabelled:
Delayed contrast enhancement (DCE) visualized by cardiac MRI (CMR) is a common feature in patients with hypertrophic cardiomyopathy (HCM), presumed to be related to myocardial fibrosis. The pathophysiologic basis of hyperenhancement in this patient group, however, remains unclear as limited histologic comparisons are available. The present study compares the perfusable tissue index (PTI), an alternative marker of myocardial fibrosis obtained by PET, with DCE-CMR in HCM.
Methods:
Twenty-one patients with asymmetric septal HCM, 12 chronic myocardial infarction (MI) patients, and 6 age-matched healthy control subjects were studied with DCE-CMR and PET. PET was performed using (15)O-labeled water and carbon monoxide to obtain the PTI.
Results:
No hyperenhancement was observed in control subjects and the PTI was within normal limits (1.10 +/- 0.07 [mean +/- SD]). In MI patients, the extent of hyperenhancement (25% +/- 16% [mean +/- SD]) was inversely related to the decrease in the PTI (0.94 +/- 0.12; r = -0.65, P < 0.05). Average hyperenhancement in HCM was 14% +/- 12%, predominantly located in the interventricular septum. The PTI in the hypertrophied interventricular septum, however, was not reduced (1.12 +/- 0.13). Furthermore, in contrast to MI patients, there was a modest positive correlation between the extent of DCE and the PTI in HCM (r = 0.45, P < 0.05).
Conclusion:
DCE in the hypertrophied septum of HCM patients is not accompanied by a decline in the PTI, and there is a positive correlation between the extent of DCE and the PTI. These results suggest that hyperenhancement may not be caused solely by fibrotic replacement scarring in this patient group. Other pathologic changes associated with HCM may also cause gadolinium-diethylenetriaminepentaacetic acid hyperenhancement.
Insights
Delayed contrast enhancement (DCE) in hypertrophic cardiomyopathy (HCM) may not solely indicate fibrosis. Perfusable tissue index (PTI) measured by PET shows a positive correlation with DCE in HCM, unlike in myocardial infarction (MI).
Area of Science:
- Cardiovascular Imaging
- Cardiology
- Medical Physics
Background:
- Delayed contrast enhancement (DCE) on cardiac MRI (CMR) is common in hypertrophic cardiomyopathy (HCM), often attributed to myocardial fibrosis.
- The exact pathophysiologic basis of this hyperenhancement in HCM remains unclear due to limited histologic data.
Purpose of the Study:
- To compare DCE-CMR findings with perfusable tissue index (PTI) measured by Positron Emission Tomography (PET) as a marker of myocardial fibrosis in HCM patients.
- To investigate the relationship between DCE and PTI in HCM and contrast it with findings in myocardial infarction (MI).
Main Methods:
- Twenty-one HCM patients, 12 MI patients, and 6 healthy controls underwent DCE-CMR and PET.
- PET utilized (15)O-labeled water and carbon monoxide to quantify PTI.
Main Results:
- In healthy controls, PTI was normal and no hyperenhancement was observed.
- In MI patients, hyperenhancement correlated inversely with decreased PTI (r = -0.65, P < 0.05).
- In HCM, hyperenhancement (14% +/- 12%) was predominantly in the septum, but PTI in the hypertrophied septum was not reduced (1.12 +/- 0.13). A positive correlation was found between DCE extent and PTI in HCM (r = 0.45, P < 0.05).
Conclusions:
- Hyperenhancement in the hypertrophied septum of HCM patients is not associated with reduced PTI.
- The positive correlation between DCE and PTI in HCM suggests hyperenhancement may involve factors beyond fibrotic scarring.
- Other pathological changes in HCM might contribute to gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) enhancement observed on CMR.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:21Imaging Studies for Cardiovascular System IV: CMRI