On cardiac MRI, the technique of 'late gadolinium enhancement' (LGE) at 10–15 minutes post-contrast is used to identify myocardial fibrosis/scar. In ischemic cardiomyopathy, LGE is characteristically:

• A Subendocardial or transmural enhancement in a coronary artery territory distribution ✓
• B Mid-wall patchy enhancement in a non-coronary territory distribution
• C Epicardial enhancement following the lateral wall of the LV
• D Diffuse subendocardial ring enhancement throughout the LV

Explanation

In ischemic cardiomyopathy, LGE follows a coronary artery territory distribution and begins in the subendocardium (the most vulnerable myocardium in ischemia, as it is farthest from epicardial supply and most susceptible to ischemia-reperfusion injury), extending transmurally with increasing infarct severity. The greater the transmural extent (>50% of wall thickness), the less likely functional recovery after revascularization. Non-ischemic cardiomyopathies (dilated CM, myocarditis) show mid-wall or epicardial enhancement in non-coronary patterns. Amyloidosis shows diffuse subendocardial enhancement. Hypertrophic CM shows LGE at the RV insertion points and hypertrophied segments.

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

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Written and medically reviewed by the StethoPrep medical team.