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The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy

James C. C. Moon, MB, BCh^*, Emma Reed, Mary N. Sheppard, FRCPath, Andrew G. Elkington, MB, BCh^*, SiewYen Ho, PhD, FRCPath, Margaret Burke, MB, FRCPath, Mario Petrou, PhD, FRCS and Dudley J. Pennell, MD, FRCP, FESC, FACC^*,*

^* Centre for Advanced Magnetic Resonance in Cardiology (CAMRIC), London, United Kingdom
Department of Histopathology, Royal Brompton and Harefield Hospitals, London, United Kingdom
Department of Paediatrics, Royal Brompton and Harefield Hospitals, London, United Kingdom
Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospitals, London, United Kingdom

View larger version (124K): [in a new window]   Figure 1 Comparison of (a) in vivo diastolic cine image, (b) in vivo gadolinium-enhanced cardiovascular magnetic resonance, (c) gross specimen of sections from an explanted heart, and (d) histologic sections stained with sirius red. All images are to the same scale. After fixation, considerable contraction has occurred. Regions of gadolinium enhancement correlate with regions of macroscopic unstained pale myocardium and regions of red-stained collagen. A representative mesocardial region, which is well defined, is marked by an arrow.

View larger version (95K): [in a new window]   Figure 2 The range of histologic findings. Reading from left to right: column 1 shows the macroscopic appearance of the basal two short-axis slices stained with sirius red, as shown in Figure 1. Column 2 shows a magnification of the box in column 1. Columns 3 and 4 show a magnification of the box in column 2 stained with sirius red and Masson's trichrome, respectively. Row a shows an area that had no late gadolinium enhancement, and there was only 3% collagen but extensive disarray (50%). Row b shows an area that had late gadolinium enhancement (arrows in Fig. 1), and the mesocardium had macroscopically scarring and extensive collagen (32%) and extensive disarray (50%).

View larger version (14K): [in a new window]   Figure 3 (A) The quantitative relationship between the percentage of pixels per segment showing late gadolinium enhancement and the percentage of collagen. (B) The qualitative relationship between the segmental scoring of late gadolinium enhancement and the percentage of collagen.