On cardiac MRI, late gadolinium enhancement (LGE) in a patient with hypertrophic cardiomyopathy most commonly appears as:

• A Subendocardial enhancement in a coronary artery distribution
• B Transmural enhancement of the anterior wall
• C Epicardial enhancement in a non-coronary distribution
• D Mid-myocardial patchy enhancement at the right-ventricular insertion points ✓

Explanation

In hypertrophic cardiomyopathy (HCM), late gadolinium enhancement (LGE) characteristically occurs in a mid-myocardial patchy pattern, most frequently at the right ventricular insertion points (anteroseptal and inferoseptal junctions) and within hypertrophied segments. LGE reflects myocyte replacement fibrosis. The amount of LGE (%LGE/LV mass) correlates with sudden cardiac death risk and is used in risk stratification. Subendocardial LGE in a coronary territory indicates ischaemic scar (MI pattern). Epicardial LGE in non-coronary distribution is typical of myocarditis.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.