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Myocardial T2 signal enhancement in hypertrophic cardiomyopathy: prevalence, clinical profile and pathologic correlation

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In this study, we examine the prevalence of T2 signal abnormalities among patients with HCM and examine for associations with other imaging-based markers of HCM phenotypic expression... In a patient planned for transplantation, a detailed in-vivo and ex-vivo imaging protocol was performed, the latter performing high-resolution isotropic T2-weighted imaging... T2 signal abnormalities were identified in 24 patients (29%)... As shown in Figure 1, these patients were younger, had greater myocardial mass and maximal wall thickness, and a greater volume of myocardial fibrosis by LGE imaging... Ex-vivo imaging confirmed high T2 signal and was used to guide histologic examination, showing the presence of unusual, large vascular channels... These were confirmed by immuno-histochemical staining to be lymphatic in origin (Figure 2)... In the largest series to date of T2-weighted imaging in HCM, we identify that T2 signal abnormalities occur in one-third of patients and are associated with an advanced disease phenotype... These patients are typically younger with more myocardial hypertrophy and fibrosis... In a patient undergoing transplantation, T2 signal was histologically correlated to abnormal lympathic channels embedded in dense fibrosis... The capacity of these channels to contribute to re-entry mechanisms of arrhythmia in patients with HCM is of particular interest.

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Correlation of late gadolinium enhancement and T2-weighted (T2) imaging findings and histopathology in a 52 yo male undergoing cardiac transplantation. Region of increased T2 signal [A] demonstrates large vascular channels embedded within dense fibrosis (arrows), staining positive for lymphatic endothelium (right panel). A reference region of fibrosis without abnormal T2 signal [B] demonstrates only fibrosis with scant fat deposits.
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Figure 2: Correlation of late gadolinium enhancement and T2-weighted (T2) imaging findings and histopathology in a 52 yo male undergoing cardiac transplantation. Region of increased T2 signal [A] demonstrates large vascular channels embedded within dense fibrosis (arrows), staining positive for lymphatic endothelium (right panel). A reference region of fibrosis without abnormal T2 signal [B] demonstrates only fibrosis with scant fat deposits.

Mentions: A total of 83 patients were studied (mean age 54.4 ± 12.5). T2 signal abnormalities were identified in 24 patients (29%). As shown in Figure 1, these patients were younger, had greater myocardial mass and maximal wall thickness, and a greater volume of myocardial fibrosis by LGE imaging. When present, abnormal T2 signal was reliably embedded within regions of dense fibrosis. Ex-vivo imaging confirmed high T2 signal and was used to guide histologic examination, showing the presence of unusual, large vascular channels. These were confirmed by immuno-histochemical staining to be lymphatic in origin (Figure 2).


Myocardial T2 signal enhancement in hypertrophic cardiomyopathy: prevalence, clinical profile and pathologic correlation
Correlation of late gadolinium enhancement and T2-weighted (T2) imaging findings and histopathology in a 52 yo male undergoing cardiac transplantation. Region of increased T2 signal [A] demonstrates large vascular channels embedded within dense fibrosis (arrows), staining positive for lymphatic endothelium (right panel). A reference region of fibrosis without abnormal T2 signal [B] demonstrates only fibrosis with scant fat deposits.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4043200&req=5

Figure 2: Correlation of late gadolinium enhancement and T2-weighted (T2) imaging findings and histopathology in a 52 yo male undergoing cardiac transplantation. Region of increased T2 signal [A] demonstrates large vascular channels embedded within dense fibrosis (arrows), staining positive for lymphatic endothelium (right panel). A reference region of fibrosis without abnormal T2 signal [B] demonstrates only fibrosis with scant fat deposits.
Mentions: A total of 83 patients were studied (mean age 54.4 ± 12.5). T2 signal abnormalities were identified in 24 patients (29%). As shown in Figure 1, these patients were younger, had greater myocardial mass and maximal wall thickness, and a greater volume of myocardial fibrosis by LGE imaging. When present, abnormal T2 signal was reliably embedded within regions of dense fibrosis. Ex-vivo imaging confirmed high T2 signal and was used to guide histologic examination, showing the presence of unusual, large vascular channels. These were confirmed by immuno-histochemical staining to be lymphatic in origin (Figure 2).

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In this study, we examine the prevalence of T2 signal abnormalities among patients with HCM and examine for associations with other imaging-based markers of HCM phenotypic expression... In a patient planned for transplantation, a detailed in-vivo and ex-vivo imaging protocol was performed, the latter performing high-resolution isotropic T2-weighted imaging... T2 signal abnormalities were identified in 24 patients (29%)... As shown in Figure 1, these patients were younger, had greater myocardial mass and maximal wall thickness, and a greater volume of myocardial fibrosis by LGE imaging... Ex-vivo imaging confirmed high T2 signal and was used to guide histologic examination, showing the presence of unusual, large vascular channels... These were confirmed by immuno-histochemical staining to be lymphatic in origin (Figure 2)... In the largest series to date of T2-weighted imaging in HCM, we identify that T2 signal abnormalities occur in one-third of patients and are associated with an advanced disease phenotype... These patients are typically younger with more myocardial hypertrophy and fibrosis... In a patient undergoing transplantation, T2 signal was histologically correlated to abnormal lympathic channels embedded in dense fibrosis... The capacity of these channels to contribute to re-entry mechanisms of arrhythmia in patients with HCM is of particular interest.

No MeSH data available.


Related in: MedlinePlus