title: A case report in cardiovascular magnetic resonance: the contrast agent matters in amyloid.
abstract: Cardiac amyloidosis is a progressive but underdiagnosed and underappreciated cause of heart failure. In the last few years, cardiovascular magnetic resonance (CMR) has become the gold standard for non invasive diagnosis of cardiac amyloidosis with the characteristic subendocardial late gadolinium enhancement.
  
  
  
  We describe a case of a patient who, in the process of aligning protocols for a trial between different centers, had a paired study with two different contrast agents, Dotarem® and MultiHance®. MultiHance® surprisingly failed to demonstrate the characteristic imaging pattern, showing only non specific late gadolinium enhancement at the inferior right ventricular insertion point and different myocardial extracellular volume fraction compared to the one obtained with Dotarem®. MultiHance® is used by many centres, because its partial blood protein binding is a strength for MR angiography, but late gadolinium enhancement, particularly non-ischemic, appears to be compromised.
  
  
  
  This case report suggests that contrast agents should be selected with caution, especially with new therapies lining up for amyloid and CMR being used as exploratory end point in clinical trials.
authors.affiliation: National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK.|Institute of Cardiovascular Science, University College London, London, UK.
authors.forename: Marianna
authors.initials: M
authors.lastname: Fontana
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.|Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Treibel
authors.affiliation: National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK.
authors.forename: Ana
authors.initials: A
authors.lastname: Martinez-Naharro
authors.affiliation: Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rosmini
authors.affiliation: Non-Invasive Cardiac Imaging, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.affiliation: National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK.
authors.forename: Julian D
authors.initials: JD
authors.lastname: Gillmore
authors.affiliation: National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Hawkins
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK. j.moon@ucl.ac.uk.|Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK. j.moon@ucl.ac.uk.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000378:metabolism*; D005682:Gadolinium / Q000378:metabolism; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Amyloidosis; CMR; Case report; Contrast