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Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization

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Abstract

Liquefactive necrosis within a large spheroid zone of mitral annular calcification (LNMAC) is an atypical but increasingly recognized variant of mitral annular calcification (MAC). Proposed MRI, echo, and CT imaging criteria for diagnosis of this unusual disease entity are discussed along with a review of the prognosis, histopathology, and management implications. A comprehensive ECHO, CT, and MRI imaging approach to diagnostic differentiation from other cardiac masses, allowing characterization of the differing components of this unusual lesion is emphasized. Differentiation from surrounding myocardium, and demonstration of peripheral ring type hyperenhancement, or hyperintense signal in the wall of this lesion, seen with specific inversion recovery MRI sequences is presented as a major diagnostic criterion. The relationship of these MRI image findings to underlying pathology is also discussed. An illustrative case vignette is provided for clinical reference.

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Acknowledgments

The authors thank Regina Hartman, Emily Kean, Diana Osborne, and the staff of the James N Gamble library at The Christ Hospital, Cincinnati, Ohio, for their unstinting and excellent assistance, not to mention forbearance, with our incessant requests for literature search and reference retrieval services. We also gratefully acknowledge The Christ Hospital Echocardiography and Cardiac MRI departments for their generous help in acquiring and assembling the images utilized in this paper.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Cardiology, Fresno Community Hospital, California Heart Medical Associates, 7215 N Fresno St # 103, Fresno, CA, 93720, USA

    S. Sanjay Srivatsa

  2. Heart and Vascular Center, Cardiac MRI unit, The Christ Hospital, Cincinnati, OH, USA

    S. Sanjay Srivatsa, David A. Collins, Melissa King-Strunk, Robert A. Pelberg & Wojciech Mazur

  3. The Lindner Clinical Trial Center, Cincinnati, OH, USA

    S. Sanjay Srivatsa, David A. Collins, Melissa King-Strunk, Robert A. Pelberg & Wojciech Mazur

  4. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Michael D. Taylor & Kan Hor

Authors
  1. S. Sanjay Srivatsa
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  2. Michael D. Taylor
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  3. Kan Hor
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  4. David A. Collins
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  5. Melissa King-Strunk
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  7. Wojciech Mazur
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Corresponding author

Correspondence to S. Sanjay Srivatsa.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10554_2011_9935_MOESM1_ESM.avi

Movie of LV modified short axis showing LNMAC at MV annulus level. Normal LV function was noted in 2and 4 chamber views (WMV 762 kb)

10554_2011_9935_MOESM2_ESM.avi

Movies showing LNMAC using GRE spoiled gradient acquisition. A mildly hyperintense center with hypointense rim is noted (WMV 18.7 MB)

10554_2011_9935_MOESM3_ESM.avi

Movies showing LNMAC using GRE spoiled gradient acquisition. A mildly hyperintense center with hypointense rim is noted (WMV 18.7 MB)

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Srivatsa, S.S., Taylor, M.D., Hor, K. et al. Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization. Int J Cardiovasc Imaging 28, 1161–1171 (2012). https://doi.org/10.1007/s10554-011-9935-x

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  • DOI: https://doi.org/10.1007/s10554-011-9935-x

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