Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan.
Radiographics. 2010 Oct;30(6):1587-602. doi: 10.1148/rg.306105519.
Myocardial fat is often seen at cardiac computed tomography (CT) and magnetic resonance (MR) imaging of healthy adults and patients with myocardial diseases. Physiologic myocardial fat develops with aging and is commonly seen at CT in the anterolateral right ventricular (RV) free wall and RV outflow tract with normal or thickened RV myocardium and a normal-sized RV in elderly patients. Pathologic conditions with myocardial fat include healed myocardial infarction (MI); arrhythmogenic RV cardiomyopathy or dysplasia (ARVC); and others, such as cardiac lipoma, lipomatous hypertrophy of the interatrial septum, tuberous sclerosis complex, dilated cardiomyopathy, and cardiomyopathy with muscular dystrophy. In patients with healed MI, CT and MR imaging show fat in left ventricular myocardium that is of normal thickness or thin and follows the distribution of the coronary artery; CT often depicts fat in mostly subendocardial regions. In patients with ARVC, characteristic CT and MR imaging findings include a thin RV outflow tract and free wall caused by subepicardial fatty infiltration; fat in the RV moderator band, trabeculae, and ventricular septum; and RV enlargement and wall motion abnormality. Recognition of patient age, characteristic locations of myocardial fat, myocardial thickness, and ventricular size helps in differentiating physiologic and pathologic myocardial fat at cardiac imaging; findings of wall motion abnormality and late gadolinium enhancement at MR imaging help narrow the diagnosis.
心肌脂肪在健康成年人和心肌疾病患者的心脏计算机断层扫描（CT）和磁共振（MR）成像中经常可见。生理性心肌脂肪随年龄增长而发展，在 CT 上通常可见于老年患者正常或增厚的右心室（RV）前外侧游离壁和 RV 流出道的 RV 心肌，以及 RV 正常大小。伴有心肌脂肪的病理性情况包括愈合的心肌梗死（MI）；致心律失常性右心室心肌病或发育不良（ARVC）；以及其他情况，如心脏脂肪瘤、房间隔脂肪肥厚、结节性硬化症、扩张型心肌病和伴肌营养不良的心肌病。在愈合的 MI 患者中，CT 和 MR 成像显示左心室心肌中的脂肪，其厚度正常或变薄，且沿冠状动脉分布；CT 常显示大部分心内膜下区域的脂肪。在 ARVC 患者中，特征性的 CT 和 MR 成像发现包括心外膜脂肪浸润引起的 RV 流出道和游离壁变薄；RV 节制带、小梁和室间隔中的脂肪；以及 RV 扩大和壁运动异常。识别患者年龄、心肌脂肪的特征位置、心肌厚度和心室大小有助于在心脏成像中区分生理性和病理性心肌脂肪；MR 成像上的壁运动异常和晚期钆增强的发现有助于缩小诊断范围。
