Caseous mitral annular calcifications: Multimodality imaging characteristics

Figure 5 A non-contrast CT image (kVp = 120, mAs = 214, DFOV = 322 mm) (A) performed after the cardiac MRI demonstrates again, a homogeneously hyperattenuating structure in the posterolateral mitral annulus (white arrow) with a shell of calcification (black arrow). This corresponded with a T1 hyperintense structure in the region of the mitral annulus (B) (TR = 5.28, TE = 2.55, FA = 12). On a screen capture from a cine balanced steady state free precession sequence, the mass shows low T2 signal (C) (TR = 3.19, TE = 1.15, FA = 40), although the shell of calcification around the mass is slightly lower in T2 intensity than the central portion of the mass (white arrowhead). A short axis, delayed enhancement, inversion recovery image (D) (TR = 4.39, TE = 1.26, FA = 13) shows central low signal intensity as well, although there is some peripheral delayed enhancement around the mass (dashed arrow).