title: Liquefaction necrosis of mitral annular calcification (LNMAC): review of pathology, prevalence, imaging and management: proposed diagnostic imaging criteria with detailed multi-modality and MRI image characterization.
abstract: Liquefactive necrosis within a large spheroid zone of mitral annular calcification (LNMAC) is an atypical but increasingly recognized variant of mitral annular calcification (MAC). Proposed MRI, echo, and CT imaging criteria for diagnosis of this unusual disease entity are discussed along with a review of the prognosis, histopathology, and management implications. A comprehensive ECHO, CT, and MRI imaging approach to diagnostic differentiation from other cardiac masses, allowing characterization of the differing components of this unusual lesion is emphasized. Differentiation from surrounding myocardium, and demonstration of peripheral ring type hyperenhancement, or hyperintense signal in the wall of this lesion, seen with specific inversion recovery MRI sequences is presented as a major diagnostic criterion. The relationship of these MRI image findings to underlying pathology is also discussed. An illustrative case vignette is provided for clinical reference.
authors.affiliation: Division of Cardiology, Fresno Community Hospital, California Heart Medical Associates, 7215 N Fresno St # 103, Fresno, CA 93720, USA. SSriv97589@aol.com
authors.forename: S Sanjay
authors.initials: SS
authors.lastname: Srivatsa
authors.forename: Michael D
authors.initials: MD
authors.lastname: Taylor
authors.forename: Kan
authors.initials: K
authors.lastname: Hor
authors.forename: David A
authors.initials: DA
authors.lastname: Collins
authors.forename: Melissa
authors.initials: M
authors.lastname: King-Strunk
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pelberg
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D004452:Echocardiography; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008943:Mitral Valve / Q000473:pathology*; D009336:Necrosis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D014057:Tomography, X-Ray Computed