Which condition shows a dilated left ventricle with poor systolic function on cine and midmyocardial enhancement on LGE?

• A. ARVC
• B. Amyloid
• C. HCM
• D. NICM

Answer: (D)

Nonischemic dilated cardiomyopathy is suggested when the left ventricle is enlarged with reduced systolic function on cine imaging and the scar pattern on late gadolinium enhancement is mid-wall rather than confined to a coronary territory. This midmyocardial (often patchy) LGE pattern distinguishes NICM from ischemic disease, where enhancement follows a vascular distribution from subendocardial to transmural. ARVC targets the right ventricle and may have LV involvement but not a typical dilated LV with mid-wall LGE; amyloidosis usually shows diffuse subendocardial or transmural enhancement with LV thickening, not a mid-wall pattern in a dilated ventricle; hypertrophic cardiomyopathy features LV thickening rather than dilation, with LGE in hypertrophied segments rather than mid-wall enhancement in a dilated ventricle.