Late gadolinium enhancement in cardiomyopathy

Excerpt

One of the most important recent breakthroughs in cardiovascular magnetic resonance (CMR) has been the use of gadolinium chelated contrast agents. These paramagnetic agents have widespread body applications, but more recently their use has increased greatly for the heart as well. These compounds accumulate in the extracellular space, as they are unable to penetrate the intact cell membranes. In the normal myocardium, where the volume of distribution is small, the wash-out is relatively rapid. On the other hand, when there is myocardial cell death or an increase of the interstitium from any cause, the extracellular volume of distribution increases and gadolinium chelated contrast agents accumulate. This accumulation is best imaged by CMR at least 10 min after injection, and is therefore termed late gadolinium enhancement. This phenomenon occurs in areas of myocardial disease which makes it valuable in the phenotyping of cardiomyopathy, a previously insuperable problem for non-invasive cardiology. …