Late enhancement: A new feature in MRI of arrhythmogenic right ventricular cardiomyopathy?

Aim of the study was to evaluate whether late enhancement (LE) in contrast-enhanced MRI can be used to characterize fibrofatty myocardial replacement in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC). Fifteen patients with suspected ARVC underwent CE-MRI using a 1.5 T scanner. Long and short axis SSFP cine images and T1-weighted fast spin echo images were collected in all patients. After injection of 0.2 mmol/kg Gd-DTPA (Magnevist, Schering, Berlin, Germany), inversion recovery gradient echo images were acquired in long and contiguous short axes to detect myocardial LE indicating areas of fibrous tissue within the myocardium. For definition of ARVC, the ESC Task force criteria were used. In 7 (47%) of 15 patients, ARVC was diagnosed based on the ESC criteria. In all of these 7 patients, MRI showed morphologic or functional criteria of ARVC according to the ESC. LE of the right ventricular myocardium was detected in 5 (71%) of the 7 ARVC patients, additional LE of the left ventricular myocardium in 2 of these patients. None of the 7 patients meeting the ARVC diagnostic criteria had fatty RV infiltration demonstrable by conventional T1-weighted imaging. Eight patients neither showed morphologic criteria of ARVC nor LE. In conclusion, late enhancement can be detected in the right and left ventricular myocardium in some ARVC patients. LE might represent intramyocardial areas of fibrous tissue.