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

  • S. Sanjay Srivatsa
  • Michael D. Taylor
  • Kan Hor
  • David A. Collins
  • Melissa King-Strunk
  • Robert A. Pelberg
  • Wojciech Mazur
Original Paper


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.


Liquefactive necrosis Mitral annular calcification MRI CT Echocardiography 

Supplementary material

10554_2011_9935_MOESM1_ESM.avi (762 kb)
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 (18.8 mb)
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 (18.8 mb)
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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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • S. Sanjay Srivatsa
    • 1
    • 2
    • 3
  • Michael D. Taylor
    • 4
  • Kan Hor
    • 4
  • David A. Collins
    • 2
    • 3
  • Melissa King-Strunk
    • 2
    • 3
  • Robert A. Pelberg
    • 2
    • 3
  • Wojciech Mazur
    • 2
    • 3
  1. 1.Division of CardiologyFresno Community Hospital, California Heart Medical AssociatesFresnoUSA
  2. 2.Heart and Vascular Center, Cardiac MRI unitThe Christ HospitalCincinnatiUSA
  3. 3.The Lindner Clinical Trial CenterCincinnatiUSA
  4. 4.Cincinnati Children’s Hospital Medical CenterCincinnatiUSA

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