Cabeda, Estevan V

Carneiro, Adriano C

Filho

Kalil, Roberto

Mady, Charles

Mochiduky, Roberta I

Moreira, Valeria M

Ribeiro, Mario S

Rochitte, Carlos E

Salemi, Vera M

Villa, Alexandre V

Zancaner, Leonardo F

English

PubMed

Salemi Vera M

Kalil Roberto

Villa Alexandre V

Ribeiro Mario S

Moreira Valeria M

Cabeda Estevan V

Zancaner Leonardo F

Mochiduky Roberta I

Carneiro Adriano C

Mady Charles

Rochitte Carlos E

Directory of Open Access Journals

Journal of Cardiovascular Magnetic Resonance

A new typical finding in late gadolinium enhanced images for the diagnosis of endomyocardial fibrosis - the double V sign

Adriano C Carneiro

Roberta I Mochiduky

Leonardo F Zancaner

Estevan V Cabeda

Valeria M Moreira

Mario S Ribeiro

Alexandre V Villa

Roberto Kalil

null Filho

Vera M Salemi

Charles Mady

Carlos E Rochitte

Crossref

Filho null

Springer - Publisher Connector

ORAL PRESENTATION Open Access
A new typical finding in late gadolinium
enhanced images for the diagnosis of
endomyocardial fibrosis - the double V sign
Adriano C Carneiro*, Roberta I Mochiduky, Leonardo F Zancaner, Estevan V Cabeda, Valeria M Moreira,
Mario S Ribeiro, Alexandre V Villa, Roberto Kalil, Filho , Vera M Salemi, Charles Mady, Carlos E Rochitte
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Introduction
Endomyocardial fibrosis (EMF) is a restrictive cardio-
myopathy presenting with ventricular apical filling, pos-
sibly containing fibrotic tissue with thrombus and/or
calcification. Late gadolinium enhancement (LGE) can
detect apical fibrosis in EMF patients, as a hyper intense
linear image usually in a letter “V” like shape pointing
to the ventricular apex. Recently, we have observed a
pattern of a double layer hyper and hypo intense in
LGE images, also in a “V” like shape, possibly corre-
sponding to fibrosis plus thrombus/calcification.
Purpose
Our objective was to investigate the frequency of fibrosis
(single V) and fibrosis associated to thrombus/calcifica-
tion (double V) in a group of patients with EMF.
Methods
We retrospectively studied 44 patients with confirmed
EMF that had undergone CMR exam in a 1.5T scanner
(GE Signa, CVi) during clinical investigation. CMR
exam included cine-SSFP with standard parameters, and
LGE images acquired 10min after 0.2mmol/kg of gadoli-
nium-based contrast and with the parameters: TR
7.2ms, TE 3.2ms, matrix 256 x 192, flip angle 20° and
inversion time (TI) 150 to 250ms, number of excitations
2 and acquisition in every heart beat (1 RR). We
adjusted TI to null the signal from normal myocardium
after contrast. Two observers independently classified
LGE long-axis images from all patients in 4 categories:
absence of fibrosis, single V fibrosis, double V fibrosis
plus thrombus/calcification and fibrotic tissue without V
shape.
Heart Institute -InCor- University of Sao Paulo Medical School, Sao Paulo,
Brazil
Figure 1
Carneiro et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O40
http://jcmr-online.com/content/13/S1/O40
© 2011 Carneiro et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Results
From the 44 patients, with mean age of 60 ± 11.8 years
old, 36 (82%) were female. Thirty-nine patients (89%)
presented apical fibrosis on the LGE images. From
those, 21(54%) had the typical aspect of double-layered
V shape of fibrosis plus thrombus/calcification, 11(28%)
had only apical fibrosis (single V) and only 7 (18%) had
fibrosis without the V shape (p<0.001 for the V sign,
Figure 1: A/B, C and D, respectively).
From the 44 patients, 16 (36%) had a biventricular, 22
(50%) LV only, and 6 (14%) had RV only involvement
by apical filling.
Conclusion
In conclusion, more than half of patients (54%) with
confirmed EMF and fibrosis presented an LGE imaging
finding of apical filling associated to a hyper and hypo
intense double-layered image, in a letter “V” like shape
pointing to the ventricular apex (double V sign). Our
data suggest that the double V sign can be considered a
typical finding in EMF patients. This realization might
help in the differential diagnosis with other apical filling
conditions, such as apical hypertrophic cardiomyopathy,
apical thrombus, and others.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-O40
Cite this article as: Carneiro et al.: A new typical finding in late
gadolinium enhanced images for the diagnosis of endomyocardial
fibrosis - the double V sign. Journal of Cardiovascular Magnetic Resonance
2011 13(Suppl 1):O40.
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Carneiro et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O40
http://jcmr-online.com/content/13/S1/O40
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A new typical finding in late gadolinium enhanced images for the diagnosis of endomyocardial fibrosis - the double V sign

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