Fig. 1

Cardiac magnetic resonance(CMR) imaging with phase-sensitive inversion-recovery (PSIR) of late gadolinium enhancement, in a representative patient with TTR cardiac amyloidosis (left, short-axis view; right, 4-chamber view). The IR timing is adjusted to null the signal from the mid wall of the myocardium, leaving the subendocardium appearing diffusely brighter. The blood pool also appears dark in the PSIR images; this otherwise unusual appearance is common in cardiac amyloid. A Magnitude images; note that there is apparent gray signal in regions of a pericardial effusion (arrows), due to rectified negative signal from areas of long-T1 fluid. B Phase-sensitive images; note that the fluid regions (arrows) now appear dark, because their signal is lower (negative) than the nulled myocardium