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Imaging of Cardiac Fibrosis: An Update, From the AJR Special Series on Imaging of Fibrosis
Gauri R Karur1,2, Ashish Aneja3, Jadranka Stojanovska4
1Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
Abstract:
Myocardial fibrosis (MF) is defined as excessive production and deposition of extra-cellular matrix proteins that result in pathologic myocardial remodeling. Three types of MF have been identified: replacement fibrosis from tissue necrosis, reactive fibrosis from myocardial stress, and infiltrative interstitial fibrosis from progressive deposition of nondegradable material such as amyloid. Although echocardiography, nuclear medicine, and CT play important roles in the assessment of MF, MRI is pivotal in the evaluation of MF, with the late gadolinium enhancement (LGE) technique used as a primary end point. The LGE technique focuses on the pattern and distribution of gadolinium accumulation in the myocardium and assists in the diagnosis and establishment of the cause of both ischemic and nonischemic cardiomyopathy. LGE MRI also aids prognostication and risk stratification. In addition, LGE MRI is used to guide the management of patients considered for ablation for arrhythmias. Parametric mapping techniques, including T1 mapping and extracellular volume measurement, allow detection and quantification of diffuse fibrosis, which may not be detected by LGE MRI. These techniques also allow monitoring of disease progression and therapy response. This review provides an update on the imaging of MF, including prognostication and risk stratification tools, electrophysiologic considerations, and disease monitoring.
Insights
Myocardial fibrosis (MF) imaging is crucial for diagnosing and managing heart conditions. Cardiac MRI, particularly late gadolinium enhancement (LGE) and parametric mapping, offers advanced insights into fibrosis patterns and extent.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Myocardial fibrosis (MF) involves excessive extracellular matrix deposition, leading to pathological cardiac remodeling.
- Three types of MF exist: replacement, reactive, and infiltrative interstitial fibrosis.
- While echocardiography, nuclear medicine, and CT have roles, MRI is pivotal for MF assessment.
Purpose of the Study:
- To review the current state of myocardial fibrosis imaging.
- To highlight the role of MRI techniques in diagnosing and managing MF.
- To discuss prognostication, risk stratification, and disease monitoring using advanced imaging.
Main Methods:
- Late Gadolinium Enhancement (LGE) MRI to assess gadolinium distribution and patterns.
- Parametric mapping techniques (T1 mapping, extracellular volume) for diffuse fibrosis detection.
- Review of existing literature on cardiac MRI for myocardial fibrosis.
Main Results:
- LGE MRI is a primary endpoint for evaluating MF, aiding in diagnosing ischemic and nonischemic cardiomyopathies.
- LGE MRI assists in prognostication, risk stratification, and guiding ablation therapy for arrhythmias.
- Parametric mapping detects and quantifies diffuse fibrosis, monitors disease progression, and assesses therapy response.
Conclusions:
- Cardiac MRI, especially LGE and parametric mapping, is essential for comprehensive myocardial fibrosis evaluation.
- Advanced MRI techniques improve diagnosis, risk stratification, and patient management for various cardiac conditions.
- Ongoing advancements in imaging facilitate better monitoring of disease progression and treatment efficacy.
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