Volume 13 Supplement 1

Abstracts of the 2011 SCMR/Euro CMR Joint Scientific Sessions

Open Access

A new typical finding in late gadolinium enhanced images for the diagnosis of endomyocardial fibrosis - the double V sign

  • Adriano C Carneiro1,
  • Roberta I Mochiduky1,
  • Leonardo F Zancaner1,
  • Estevan V Cabeda1,
  • Valeria M Moreira1,
  • Mario S Ribeiro1,
  • Alexandre V Villa1,
  • Roberto Kalil1,
  • Filho1,
  • Vera M Salemi1,
  • Charles Mady1 and
  • Carlos E Rochitte1
Journal of Cardiovascular Magnetic Resonance201113(Suppl 1):O40

DOI: 10.1186/1532-429X-13-S1-O40

Published: 2 February 2011

Introduction

Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy presenting with ventricular apical filling, possibly containing fibrotic tissue with thrombus and/or calcification. Late gadolinium enhancement (LGE) can detect apical fibrosis in EMF patients, as a hyper intense linear image usually in a letter “V” like shape pointing to the ventricular apex. Recently, we have observed a pattern of a double layer hyper and hypo intense in LGE images, also in a “V” like shape, possibly corresponding to fibrosis plus thrombus/calcification.

Purpose

Our objective was to investigate the frequency of fibrosis (single V) and fibrosis associated to thrombus/calcification (double V) in a group of patients with EMF.

Methods

We retrospectively studied 44 patients with confirmed EMF that had undergone CMR exam in a 1.5T scanner (GE Signa, CVi) during clinical investigation. CMR exam included cine-SSFP with standard parameters, and LGE images acquired 10min after 0.2mmol/kg of gadolinium-based contrast and with the parameters: TR 7.2ms, TE 3.2ms, matrix 256 x 192, flip angle 20° and inversion time (TI) 150 to 250ms, number of excitations 2 and acquisition in every heart beat (1 RR). We adjusted TI to null the signal from normal myocardium after contrast. Two observers independently classified LGE long-axis images from all patients in 4 categories: absence of fibrosis, single V fibrosis, double V fibrosis plus thrombus/calcification and fibrotic tissue without V shape.

Results

From the 44 patients, with mean age of 60 ± 11.8 years old, 36 (82%) were female. Thirty-nine patients (89%) presented apical fibrosis on the LGE images. From those, 21(54%) had the typical aspect of double-layered V shape of fibrosis plus thrombus/calcification, 11(28%) had only apical fibrosis (single V) and only 7 (18%) had fibrosis without the V shape (p<0.001 for the V sign, Figure 1: A/B, C and D, respectively).

Figure 1

From the 44 patients, 16 (36%) had a biventricular, 22 (50%) LV only, and 6 (14%) had RV only involvement by apical filling.

Conclusion

In conclusion, more than half of patients (54%) with confirmed EMF and fibrosis presented an LGE imaging finding of apical filling associated to a hyper and hypo intense double-layered image, in a letter “V” like shape pointing to the ventricular apex (double V sign). Our data suggest that the double V sign can be considered a typical finding in EMF patients. This realization might help in the differential diagnosis with other apical filling conditions, such as apical hypertrophic cardiomyopathy, apical thrombus, and others.

Authors’ Affiliations

(1)
Heart Institute -InCor- University of Sao Paulo Medical School

Copyright

© Carneiro et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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