# Left Ventricular Non-Compaction Cardiomyopathy-Still More Questions than Answers
## 4 Diagnostic Methods
### Magnet Resonance Imaging
\begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Author** & **Method** & **Diagnostic Criteria** & **Cardiac Phase** & **Cut-Off** \\ \hline \multirow{4}{*}{**[PERSON]**[42]} & \multirow{4}{*}{CMR} & Ratio of compacted & \multirow{4}{*}{End diastole} & \multirow{4}{*}{NC/C \(\geq\) 2.3} \\  & & epicardium and & & \\  & & non-compacted & & \\  & & endocardium & & \\ \hline \multirow{4}{*}{**[PERSON]**[43]} & \multirow{4}{*}{CMR} & Ratio of compacted & \multirow{4}{*}{Short axis, end-systole} & \multirow{4}{*}{NC/C ratio of \(\geq\) 2.0} \\  & & epicardium and & & \\  & & non-compacted & & \\  & & endocardium & & \\ \hline \multirow{2}{*}{**[PERSON]**[44]} & \multirow{2}{*}{CMR} & A value of trabeculated LV & \multirow{2}{*}{End diastole} & LV trabeculated \\  & & mass above 20\% of the & global mass of the LV & & mass \textgreater{} 20\%\) \\ \hline \multirow{4}{*}{**[PERSON]**[39]} & \multirow{4}{*}{CMR} & Ratio of total LV & \multirow{4}{*}{End systole} & \multirow{4}{*}{The speculated ventricular mass greater than 25\% of the global left ventricular mass; noncompacted mass greater than 15 g/m\({}^{2}\)} \\  & & & & \\ \hline \multirow{4}{*}{**[PERSON]**[45]} & \multirow{4}{*}{CMR} & A percentage of \multirow{4}{*}{End-diastole, long-axis} & \multirow{4}{*}{LV trabeculated} \\  & & trabeculated myocardial volume of the total & & \\ \cline{1-1}  & & myocardial volume & & \\ \cline{1-1}  & & of the LV & & \\ \hline \multirow{2}{*}{**Captur**[46]} & \multirow{2}{*}{CMR} & \multirow{2}{*}{Maximal fractal dimension} & \multirow{2}{*}{End diastole} & Global fractal \\  & & & & dimension \textgreater{} 1.26; apical \\ \hline \multirow{4}{*}{**Chin**[3]} & \multirow{4}{*}{ECHO} & The ratio of the distance & \multirow{4}{*}{Long axis, end diastole} & \multirow{4}{*}{X/Y \(\leq\) 0.5} \\  & & from the deepest trabecular & & \\ \cline{1-1}  & & recess to the epicardial & & \\ \cline{1-1}  & & surface (X) and the distance from the tip of the & & \\ \cline{1-1}  & & trabeculation to the & & \\ \cline{1-1}  & & epicardial surface (Y) & & \\ \hline \hline \end{tabular}
\end{table} 
Table 2: LVNC diagnostic criteria. Figure 4: CMR examination: Thromus in the apex of the left ventricle in a patient with LVNC (**A**,**B**) (arrow). (**C**) Short-axis view, late-enhanced sequence (PSIR). Extensive intramyocardial LGE in the septum (arrowheads). The MRI diagnostic criteria proposed by [PERSON] et al. are generally the most accepted [42]. [PERSON]'s criteria were based on two approaches; first, on the long axis, and second, on the short axis. In both, segments 17 (AHA) and papillary muscle were excluded. An end-diastolic ratio between non-compacted and compacted layers greater than 2.3 is considered diagnostic of myocardial noncompaction with specificity (99%), sensitivity (86%), positive prediction (75%), and negative prediction (99%) [42]. [PERSON] et al. took a different strategy. They depicted LVNC only in the short axis with a diagnostic NC/C ratio of \(\geq\) 2.0 in end-systole [43]. [PERSON] et al. have used another method to measure end-diastolic global and trabeculated LV mass. They applied the following equation: (LV mass with trabeculations--LV mass without trabeculations)/(LV mass without trabeculations) \(\times\) 100. Ruling in cut-off was >20% [44]. The same approach has been used by [PERSON] et al. with a higher cut-off of >35% [45]. [PERSON] et al. reported a trabeculated ventricular mass of more than 25% of the global LV mass and a non-compacted mass of more than 15 g/m\({}^{2}\) as highly sensitive and specific for the diagnosis of LVNC [39]. The Grothoff criteria give also an opportunity to differentiate the LVNC from excessive trabeculation associated with thalassemia [49]. The noncompaction-to-compaction ratio > 2 measured in myocardial segments 4-6 suggests a high probability of LVNC. The maximal fractal dimension was used to diagnose LVNC by [PERSON] et al. [46]. Global fractal dimension > 1.26 and apical fractal dimension > 1.3 were found in patients with LVNC.