Cardiac amyloidosis is rare, but when diagnosed it has an urgent and specific treatment. Two patients with similar concentric left ventricular hypertrophy on echocardiography were investigated with cardiac magnetic resonance (CMR) to differentiate cardiac amyloidosis from hypertrophic cardiomyopathy.
In the setting of hypertrophic cardiomyopathy, early hyperenhancement occurs around 200 ms, comparable to normal ( Fig. 1 , arrows in top and middle rows). Late myocardium enhancement is characterized by multiple non-specific interstitial nodules within the hypertrophic myocardium suggesting interstitial fibrosis. When a diagnosis of cardiac amyloidosis is established, CMR demonstrates late subendocardial enhancement on delayed images associated with a short inversion time, around 150 ms ( Fig. 1 , arrow in bottom row).
