Lipomatous metaplasia of the myocardium

Radiopaedia • CC-by-nc-sa 3.0 • de

Lipomatous metaplasia of the myocardium is a phenomenon where there is fat deposition within the myocardium. It is often seen following a myocardial infarction but can also rarely been seen in conditions such as arrhythmogenic right ventricular dysplasia.

Pathology

The exact etiology of lipomatous metaplasia is not known, but it is not seen in the absence of substitutive myocardial fibrosis.

Radiographic features

Echocardiography

Lipomatous hyperplasia may not be detectable on echocardiography .

Scintigraphy

Lipomatous hyperplasia may not be detectable on myocardial perfusion imaging as lipophilic myocardial perfusion agents such as tetrofosmin and sestamibi may well be taken up into fat cells .

Cardiac CT

May show areas of fat attenuation within the affected myocardial region.

Cardiac MRI
  • T1: affected regions are high signal and show signal dropout in fat suppressed sequences. 
  • IR (inversion recovery): the adipose tissue has high signal intensity
  • C+ (Gd): may not enhance but affected areas are seen surrounded by areas of myocardial fibrosis demonstrated on late contrast‐enhanced (LCE) images .