Patterns of myocardial late enhancement: typical and atypical features

Myocardial late enhancement, an imaging technique acquired after gadolinium administration, has become an integral part of cardiovascular magnetic resonance imaging over the past decade. Initially principally utilized for imaging myocardial infarction, more recently it has also become an invaluable tool for identifying myocardial scarring in other cardiomyopathic processes. Our experience using this technique has led us to identify several manifestations of late gadolinium enhancement imaging that can confound interpretation of pathology and potentially lead to misinterpretation and subsequently misdiagnosis for the patient. The purpose of this article is to review and illustrate typical and atypical myocardial late enhancement in the most common myocardial diseases seen in routine clinical practice.