# Left Ventricular Non-Compaction Cardiomyopathy-Still More Questions than Answers
## 4 Diagnostic Methods
### Magnet Resonance Imaging  
Thanks to its ability to display anatomic details and functional information, cardiac magnetic resonance (CMR) has become the method of choice for diagnosing noncompaction cardiomyopathy [37]. Balanced steady-state free precession (SSFP) cite imaging and its high resolution allow very accurate assessment of the myocardium, in particular, differentiation of compact and non-compact myocardium (Figures 2 and 3) [38]. Representation of the myocardium in different planes is the principal advantage of CMR. In addition, the possibility to visualize intracardiac thrombi is of clinical value (Figure 4A,B). The late gadolinium enhancement (LGE) helps rule out concomitant or underlying fibrosis (Figure 4C). The 3D approach allows taking the entire volume of the heart in each favorable view without the usual restriction of echocardiography [39]. Poor echocardiographic windows, difficulties with depicting the apex, and examiner dependency are known limitations of echocardiography and are not the case in CMR [39]. Therefore, the probability of missing segmental myocardial changes is significantly lower in CMR compared to echo. It  
Figure 1: Transthoracic echocardiographic examination, patient with LVNC. (**A**) Parasternal short axis, 2D, diastole, right with color doppler. (**B**) Parasternal short axis, 2D, systole, right with color doppler. (**C**) Apical 4-chamber view, 2D, diastole. Left—note excessive trabeculation of the left ventricle. The white arrow shows the deep trabecular recess between the trabeculation. Right—healthy patient with a normal left ventricle. (**D**) Zoomed view of the same patient, apex, and apical segments of the lateral wall. Note excessive trabeculation of the left ventricle. The white arrow shows the deep trabecular recess between the trabeculation. (**E**) Zoomed view with color doppler of the same patient, apex, and apical segments of the lateral wall. Note excessive trabeculation of the left ventricle filled with blood as seen with color doppler (arrows). (**F**) Contrast echocardiography (SonoVue), modified apical 4 chamber view, end-diastole, patient with LVNC. Note the deep trabecular recess between trabeculation of the left ventricle filled with contrasted blood. should also be noted that CMR provides additional information about the mediastum and thoracic structures [40]. In contrast, higher costs, relatively long acquisition times, and limited availability may make cardiac CMR a second-line imaging technique generally used after echocardiography. Figure 3: CMR examination: (**A**) Three-chamber view, diastole; (**B**) three-chamber view, systole; (**C**) four-chamber view, diastole; (**D**) four-chamber view, systole. Cine steady-state free precession images at end-diastole and end-systole. Note an increased number of trabeculations along the LV lateral wall and LV apex (arrows). (**E**) Long-axis right ventricular view, cine steady-state free precession image of the right ventricle showing prominent hypertrabec  
Figure 2: CMR examination. 25 years old male. Basal, midventricular, and apical cine steady-state free precession images in short-axis orientation during end-diastole and end-systole. Note differentiation between non-compacted from compacted myocardium. Typically, routing protocols in CMR include both cine SSFP images and black blood. It is important to compare both images simultaneously to avoid over or underestimation [41]. There is various literature in which criteria for LVNC have been described (Table 2).