{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T13:18:58Z","timestamp":1780406338698,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T00:00:00Z","timestamp":1677369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Cardiac ventricular outpouchings and invaginations are rare structural abnormalities and usually incidental findings during cardiac imaging. A definitive diagnosis is possible through the use of multimodality imaging. A systematic review of the literature was carried out in November 2022 to identify studies regarding ventricular outpouchings and invaginations. The main aim of the review is to summarize knowledge regarding epidemiology, etiology, diagnosis and prognosis of patients with ventricular outpouchings (aneurisms or diverticula) and invaginations (crypts and recesses). Overall, 26 studies published between 2000 and 2020 were included in the review. Diverticula and congenital aneurysms incidence ranges between 0.6 and 4.1%. Myocardial recesses and crypts range between 9% in the general population and up to 25% in patients with hypertrophic cardiomyopathy. The combined use of echocardiography, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) is useful to establish tissue contractility, fibrosis, extension and relationship with adjacent structures for differential diagnosis of both invaginations and outpouchings. In conclusion, both outpouchings and invaginations are rare entities: a definitive diagnosis may be aided by the use of combining multiple imaging techniques, and the treatment depends both on the lesion-specific risk of complications and on the potential association of some lesions with cardiomyopathy.<\/jats:p>","DOI":"10.3390\/life13030650","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T04:05:40Z","timestamp":1677470740000},"page":"650","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Use of Multimodality Imaging for the Diagnosis of Myocardial Outpouchings and Invaginations: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1763-9711","authenticated-orcid":false,"given":"Rita","family":"Pavasini","sequence":"first","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"},{"name":"Rita Pavasini, Cardiology Unit, Azienda Ospedaliero Universitaria S. Anna, Via Aldo Moro 8, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4643-1629","authenticated-orcid":false,"given":"Nicola","family":"Bianchi","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Frascaro","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2622-4881","authenticated-orcid":false,"given":"Federico","family":"Marchini","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Meossi","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Zanarelli","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2465-3327","authenticated-orcid":false,"given":"Federico","family":"Sanguettoli","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cossu","sequence":"additional","affiliation":[{"name":"University Radiology Unit, University of Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Tonet","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Passarini","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5150-188X","authenticated-orcid":false,"given":"Gianluca","family":"Campo","sequence":"additional","affiliation":[{"name":"UO Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00246-014-0885-7","article-title":"Anterosuperior Diverticula of the Right Ventricle: Morphological Spectrum and Long-Term Outcome of a Distinct Cardiac Anomaly","volume":"35","author":"Wiegand","year":"2014","journal-title":"Pediatr. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1161\/CIRCIMAGING.114.001744","article-title":"Myocardial clefts, crypts, or crevices: Once again, you see only what you look for","volume":"7","author":"Basso","year":"2014","journal-title":"Circ. Cardiovasc. Imag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/jcu.23155","article-title":"Echocardiographic features of left ventricular recess, cleft, diverticulum, and aneurysm: A systematic review","volume":"50","author":"Ali","year":"2022","journal-title":"J. Clin. Ultrasound JCU"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1253\/circj.CJ-08-0995","article-title":"Left ventricular noncompaction","volume":"73","author":"Ichida","year":"2009","journal-title":"Circ. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12968-014-0066-0","article-title":"Prevalence of myocardial crypts in a large retrospective cohort study by cardiovascular magnetic resonance","volume":"16","author":"Child","year":"2014","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_6","first-page":"n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","article-title":"Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument","volume":"73","author":"Slim","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"204","DOI":"10.2214\/AJR.06.1223","article-title":"Ventricular Diverticula on Cardiac CT: More Common Than Previously Thought","volume":"189","author":"Srichai","year":"2007","journal-title":"Am. J. Roentgenol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jtcvs.2005.09.046","article-title":"Diagnosis and outcome in congenital ventricular diver-ticulum and aneurysm","volume":"131","author":"Marijon","year":"2006","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.amjcard.2007.02.094","article-title":"Usefulness of Magnetic Resonance Imaging Evaluation of Congenital Left Ventricular Aneurysms","volume":"100","author":"McMahon","year":"2007","journal-title":"Am. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/RTI.0b013e31821255ae","article-title":"Left and right ventricular diverticula: Incidence and imaging findings on 256-slice multide-tector computed tomography","volume":"27","author":"Nakazono","year":"2012","journal-title":"J. Thorac. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5334\/jbr-btr.494","article-title":"Left ventricular diverticulum: Incidental finding on dual source cardiac CT","volume":"94","author":"Janssen","year":"2011","journal-title":"J. Belg. De Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"562","DOI":"10.2459\/JCM.0b013e3283654be5","article-title":"Prognostic role of isolated left ventricular di-verticuli detected by cardiovascular magnetic resonance","volume":"16","author":"Aquaro","year":"2015","journal-title":"J. Cardiovasc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/S0002-9149(02)02621-8","article-title":"Left ventricular outflow tract pseudoaneurysms in congenital heart disease","volume":"90","author":"Gelehrter","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S1054-8807(00)00041-7","article-title":"Subvalvular left ventricular aneurysms","volume":"9","author":"Deshpande","year":"2000","journal-title":"Cardiovasc. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1161\/CIRCIMAGING.113.001241","article-title":"Prevalence of Inferobasal Myocardial Crypts Among Patients Referred for Cardiovascular Magnetic Resonance","volume":"7","author":"Petryka","year":"2014","journal-title":"Circ. Cardiovasc. Imag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s10554-019-01543-7","article-title":"Prevalence and morphology of myocardial crypts in normal and hypertrophied myocardium by computed tomography","volume":"35","author":"Arow","year":"2019","journal-title":"Int. J. Cardiovasc. Imag."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1016\/j.jacc.2006.08.036","article-title":"Structural Abnormalities of the Inferoseptal Left Ventricular Wall Detected by Cardiac Magnetic Resonance Imaging in Carriers of Hypertrophic Cardiomyopathy Mutations","volume":"48","author":"Germans","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1532-429X-14-13","article-title":"Clinical Utility of Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy","volume":"14","author":"Maron","year":"2012","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/ehjci\/jes005","article-title":"Multiple myocardial crypts on modified long-axis view are a specific finding in pre-hypertrophic HCM mutation carriers","volume":"13","author":"Brouwer","year":"2012","journal-title":"Eur. Heart J. Cardiovasc. Imag."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1111\/echo.14393","article-title":"Structural abnormalities in hypertrophic cardiomyopathy beyond left ventricular hypertrophy by multimodality im-aging evaluation","volume":"36","author":"Niella","year":"2019","journal-title":"Echocardiography"},{"key":"ref_22","first-page":"75","article-title":"Left ventricular myocardial crypts: Morphological patterns and prognostic implications","volume":"22","author":"Pham","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ijcard.2009.03.125","article-title":"Congenital ventricular diverticula: Which type of diagnostic tool is sufficient for diagnosis?","volume":"147","author":"Cay","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e628","DOI":"10.1016\/j.ejrad.2013.07.001","article-title":"Left ventricular clefts and diverticula","volume":"82","author":"Ozturk","year":"2013","journal-title":"Eur. J. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/jocs.12059","article-title":"Ventricular Diverticulum: A Review of the Literature","volume":"28","author":"Li","year":"2013","journal-title":"J. Card. Surg."},{"key":"ref_26","first-page":"750","article-title":"Congenital left ventricular aneurysms and diverticula: An entity in search of an identity","volume":"14","author":"Ohlow","year":"2017","journal-title":"J. Geriatr. Cardiol. JGC"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/jcecho.jcecho_72_17","article-title":"Multimodality Imaging and Clinical Significance of Con-genital Ventricular Outpouchings: Recesses, Diverticula, Aneurysms, Clefts, and Crypts","volume":"28","author":"Cresti","year":"2018","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3276","DOI":"10.1016\/j.ejrad.2012.03.025","article-title":"Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: Clefts, aneurysms, diverticula and terminology problems","volume":"81","author":"Erol","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_29","first-page":"170","article-title":"Left ventricular noncompaction cardiomyopathy","volume":"3","author":"Shemisa","year":"2013","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"W519","DOI":"10.2214\/AJR.13.12326","article-title":"Left Ventricular Noncompaction: Imaging Findings and Diagnostic Criteria","volume":"204","author":"Zuccarino","year":"2015","journal-title":"Am. J. Roentgenol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.jcct.2012.07.001","article-title":"Left ventricular noncom-paction: A proposal of new diagnostic criteria by multidetector computed tomography","volume":"6","author":"Meave","year":"2012","journal-title":"J. Cardiovasc. Comput. Tomogr."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/650\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:43:08Z","timestamp":1760121788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/3\/650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,26]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["life13030650"],"URL":"https:\/\/doi.org\/10.3390\/life13030650","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,26]]}}}