CTICasesCardiac AL Amyloidosis — Late-Phase CT Enhancement Pattern
Imaging findings
Portal venous phase CT in an elderly woman with heart failure with preserved ejection fraction demonstrates diffuse late myocardial enhancement involving the left and right ventricular myocardium with relative sparing of the subendocardium, bilateral pleural effusions, and enlarged atria. An earlier arterial-phase CT from the same patient did not show appreciable myocardial enhancement.
Key takeaways
Cardiac amyloidosis is most reliably diagnosed by MRI with late gadolinium enhancement, but delayed-phase CT (portal venous or late phase) can reveal diffuse late myocardial enhancement due to the expanded extracellular volume occupied by amyloid protein, analogous to the pattern on MRI. This finding may be incidentally identified on routine CT and should prompt consideration of amyloid cardiomyopathy in the setting of a restrictive clinical picture and elevated serum free light chains.
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