Abstract
Intramyocardial fat can be observed in different pathologic processes including arrhythmogenic right ventricular cardiomyopathy (ARVC) and in old myocardial infarction (OMI) In SSFP images, fat is hyperintense and surrounded by a black boundary, called “Indian Ink” artifact that is generated when fat and water coexist in the same voxel. Aim of this study was to compare the SSFP with the conventional FSE and STIR (FSE/STIR) method for the detection of LV intramyocardial fat. Fifty-four consecutive patients with OMI (>1,000 days) and 69 patients with a diagnosis of ARVC underwent magnetic resonance. LV fat was detected in 29 patients (53.7%) in SSFP images and in 28 patients (51.9%) in FSE/STIR images. At Bland- Altman plot a close agreement was found between the extent of fat measured in SSFP images and in FSE images. However, a slight systematic overestimation, was found for the fat quantification in the SSFP images. In the ARVC group, both FSE/STIR and SSFP images evidenced fat infiltration in LV myocardium in 11 patients (15.9%) without any mismatch. SSFP had 100% sensitivity and 98.8% of specificity to detect LV intramyocardial fat in ARVC and in ischemic heart disease. SSFP sequence with TR/TE = 2 is capable in identifying and quantifying the presence of fat tissue within the LV myocardium in patients with previous myocardial infarction and ARVC.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tansey DK, Aly Z, Sheppard MN (2005) Fat in the right ventricle of the normal heart. Histopathology 46:98–104
Rakar S, Sinagra G, Di Lenarda A, Poletti A, Bussani R, Silvestri F, Camerini F (1997) Epidemiology of dilated cardiomyopathy. A prospective post-mortem study of 5252 necropsies. The Heart Muscle Disease Study Group. Eur Heart J 18:117–123
Basso C, Thiene G (2007) Autopsy and endomyocardial biopsy findings. In: Markus FI, Nava A, Thiene G (eds) Arrhythmogenic RV cardiomyopathy/dysplasia: recent advances. Springer, Italia
Nucifora G, Aquaro GD, Masci PG, Barison A, Todiere G, Pingitore A, Lombardi M (2011) Lipomatous metaplasia in ischemic cardiomyopathy: current knowledge and clinical perspective. Int J Cardiol 146(1):120–122
Baroldi G, Silver MD, De Maria R, Parodi O, Pellegrini A (1997) Lipomatous metaplasia in left ventricular scar. Can J Cardiol 13:65–71
Su L, Siegel JE, Fishbein MC (2004) Adipose tissue in myocardial infarction. Cardiovasc Pathol 13:98–102
Bley TA, Wieben O, Francois CJ, Brittain JH, Reeder SB (2010) Fat and water magnetic resonance imaging. J Magn Reson Imaging 31:4–18
Sekihara K (1987) Steady-state magnetizations in rapid NMR imaging using small flip angles and short repetition intervals. IEEE Trans Med Imaging 6:157–164
Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation 121:1533–1541
Aquaro GD, Pingitore A, Strata E, Di Bella G, Molinaro S, Lombardi M (2010) Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology. J Am Coll Cardiol 56:1235–1243
Hargreaves BA, Vasanawala SS, Nayak KS, Hu BS, Nishimura DG (2003) Fat-suppressed steady-state free precession imaging using phase detection. Magn Reson Med 50:210–213
Positano V, Pingitore A, Giorgetti A, Favilli B, Santarelli MF, Landini L, Marzullo P, Lombardi M (2005) A fast and effective method to assess myocardial necrosis by means of contrast magnetic resonance imaging. J Cardiovasc Magn Reson 7:487–494
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Alfakih K, Plein S, Thiele H, Jones T, Ridgway JP, Sivananthan MU (2003) Normal human left and right ventricular dimensions for MRI as assessed by turbo gradient echo and steady-state free precession imaging sequences. J Magn Reson Imaging 17:323–329
Goldfarb JW, Roth M, Han J (2009) Myocardial fat deposition after left ventricular myocardial infarction: assessment by using MR water-fat separation imaging. Radiology 253:65–73
Basso C, Thiene G (2005) Adipositas cordis, fatty infiltration of the right ventricle, and arrhythmogenic right ventricular cardiomyopathy. Just a matter of fat? Cardiovasc Pathol 14:37–41
Corrado D, Basso C, Thiene G, McKenna WJ, Davies MJ, Fontaliran F, Nava A, Silvestri F, Blomstrom-Lundqvist C, Wlodarska EK, Fontaine G, Camerini F (1997) Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol 30:1512–1520
Nakatsu M, Hatabu H, Itoh H, Morikawa K, Miki Y, Kasagi K, Shimono T, Shoji K, Shimada Y, Imamura M, Konishi J (2000) Comparison of short inversion time inversion recovery (STIR) and fat-saturated (chemsat) techniques for background fat intensity suppression in cervical and thoracic MR imaging. J Magn Reson Imaging 11:56–60
Acknowledgments
We thank all technicians of our magnetic resonance unit for technical and organisational assistance.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aquaro, G.D., Nucifora, G., Pederzoli, L. et al. Fat in left ventricular myocardium assessed by steady-state free precession pulse sequences. Int J Cardiovasc Imaging 28, 813–821 (2012). https://doi.org/10.1007/s10554-011-9886-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-011-9886-2