CTICasesCardiac Amyloidosis with T1 Mapping and Extracellular Volume Quantification
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Imaging findings
Cardiac MRI shows bilateral effusions, diffuse thickening of the LV wall (with normal to increased systolic function). Delayed enhancement imaging reveals subtle subendocardial enhancement in the atria and diffuse atrial subendocardial enhancement, thickening of the interatrial septum sparing the fossa. T1 mapping demonstrates abnormally increased native T1 values (1166 ms vs. normal 990-1000 ms) and a calculated extracellular volume (ECV) over 40% (vs. normal ~28%), indicative of diffuse amyloid deposition.
Key takeaways
Cardiac amyloidosis presents with diffuse myocardial thickening and can show subtle atrial subendocardial delayed enhancement, thickening of the interatrial septum, and a "tiger stripe" pattern. T1 mapping and extracellular volume (ECV) quantification are advanced MRI techniques that can detect and characterize diffuse myocardial fibrosis or deposition (like amyloid) even in subtle cases, providing objective measurements of disease burden.
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