Interpreting a Thick Myocardium on Cardiac MR: A Practical Guide for Radiologists

Area of Science:

• Cardiovascular Imaging
• Radiology
• Cardiac Magnetic Resonance

Background:

• Increased myocardial wall thickness is a common finding requiring differential diagnosis.
• Cardiac MR (CMR) imaging offers comprehensive assessment of myocardial morphology and tissue characteristics.
• Differentiating pathological hypertrophy from physiological or pseudothickening is crucial for patient management.

Purpose of the Study:

• To propose a practical CMR-based approach for interpreting increased myocardial wall thickness.
• To systematically distinguish true pathological hypertrophy from other causes.
• To review various conditions causing myocardial thickening and their characteristic CMR features.

Main Methods:

• Cine imaging for hypertrophy distribution and ventricular size.
• T1/T2 mapping and extracellular volume for fibrosis, inflammation, and infiltration.
• Late gadolinium enhancement for tissue injury patterns.
• Strain analysis for functional impairment.

Main Results:

• CMR enables detailed assessment of myocardial morphology and tissue properties.
• Specific CMR techniques help differentiate various causes of myocardial thickening.
• Characteristic CMR features are associated with hypertrophic cardiomyopathy, infiltrative diseases, and hypertensive heart disease.

Conclusions:

• A structured CMR approach is valuable for diagnosing the etiology of increased myocardial wall thickness.
• CMR imaging plays a central role in the differential diagnosis of myocardial hypertrophy.
• Understanding CMR features aids in identifying specific conditions like cardiac amyloidosis, Fabry disease, and hypertensive heart disease.