On echocardiography-guided cardiac MRI of a 50-year-old man with recent anterior STEMI, late gadolinium enhancement (LGE) is noted in the mid-wall of the inferior and inferolateral segments bilaterally. This mid-wall pattern is distinct from subendocardial or transmural enhancement. What is the most likely aetiology of this LGE pattern?

• A Completed acute myocardial infarction in the RCA territory
• B Non-ischaemic dilated cardiomyopathy ✓
• C Hypertrophic cardiomyopathy
• D Cardiac amyloidosis

Explanation

In ischaemic cardiomyopathy, LGE follows a coronary distribution and starts at the subendocardium, progressing outward with increasing infarct transmurality. Mid-wall or epicardial LGE that does not respect a coronary territory is the hallmark of non-ischaemic cardiomyopathy, most commonly dilated cardiomyopathy. Hypertrophic cardiomyopathy produces patchy mid-wall enhancement at the RV insertion points. Cardiac amyloidosis classically shows global subendocardial or diffuse transmural LGE with characteristic dark-blood nulling difficulty.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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