CTICasesIntramyocardial Lipoma Detected by Tissue Mapping
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Imaging findings
A mass was identified in the posterior aspect at the base of the left ventricle, specifically in the inferior lateral segment. Pronounced chemical shift artifact was noted around the lesion. Native T1 mapping sequences revealed a significantly short T1 inversion time for the lesion, much lower than normal myocardium (normal ~950-1000 ms, lesion considerably less), indicating the presence of fat. The lesion appeared pitch black on the initial tissue mapping images, even before contrast administration.
Key takeaways
This case demonstrates the utility of cardiac MRI tissue mapping sequences, particularly native T1 mapping, in characterizing myocardial lesions, even when performed as part of a general infiltrative cardiomyopathy protocol. The characteristic short T1 without gadolinium is pathognomonic for fat, allowing for the fortuitous diagnosis of an intramyocardial lipoma and showcasing the advantages of tissue mapping for tissue characterization.
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