Delayed myocardial enhancement, as seen on cardiac MRI, occurs when gadolinium contrast material seeps into fibrotic or necrotic myocardial tissue. It is due to a number of etiologies, and has variable appearances.
subendocardial enhancement indicates an ischemic etiology
transmural enhancement is nonspecific, but suggestive of an ischemic etiology
mid-wall enhancement indicates a non-ischemic etiology (e.g. myocarditis, idiopathic dilated cardiomyopathy)
diffuse patchy areas of enhancement are seen in cardiac amyloidosis
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