CTICasesCardiac Amyloidosis
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Imaging findings
Cardiac MRI demonstrates circumferential left ventricular hypertrophy and a depressed ejection fraction of approximately 43%. Inversion time (TI) mapping reveals an abnormal myocardial nulling pattern, where the myocardium nulls earlier than the blood pool, reversing the normal relationship (where the blood pool nulls first, followed by the myocardium and spleen). Echocardiography supports the diagnosis with a characteristic "speckled" appearance of the hypertrophied myocardium.
Key takeaways
Cardiac amyloidosis is an infiltrative cardiomyopathy characterized by extracellular amyloid deposition. On cardiac MRI TI mapping, the markedly expanded extracellular volume in the myocardium absorbs gadolinium, leading to exceptionally fast T1 recovery; this causes the myocardium to null prior to the blood pool, a finding that is highly specific for amyloidosis.
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