Abstract： Objective To investigate the cardiac MRI characteristics of patients with pure T-wave inversion and wall thickness less than apical hypertrophic cardiomyopathy diagnostic criteria. Methods Thirty-one patients from June 2012 to June 2014 with pure T-wave inversion and 32 healthy controls were retrospectively enrolled into this study. The left ventricular (LV) wall thickness was measured based on an AHA 17-segment model, as well as the apical angles (apA). The variations of LV thickness from base to apex, from the septum to free wall, and the ratio of maximal apical thickness to segment 4 were calculated and analysed. One-way ANOVA was used to analysis the thickness differences among the basal, middle and apical walls of left ventricular. In addition, student t test was also used to compare the differences of apical thickness, apA, LV ejective fraction and other cardiac function parameters of MRI between the two groups.&nbsp;In control groups the LV wall showed a trend of gradual thinning from base to apex. The thicknesses of basal, middle and apical were (7.51 ± 0.87), (6.27 ± 1.11), (3.57 ± 0.52) mm, a statistically significant difference (F=171.78, P<0.01). The ratio of maximal apical segment to segment 4 was 0.63±0.20. The LV wall of patients with pure T-wave inversion lost the trend of gradual thinning from base to apex. The thicknesses of basal, middle and apical also showed statistically significant difference (F=6.81, P<0.01) , which were (7.70 ± 0.92), (6.55 ± 0.94), (7.35 ± 1.14) mm, respectively. The ratio of the maximal apical thickness to segment 4 was 1.14 ± 0.24 in patients. The apical thickness of patients was significantly greater than that of control's (t=-11.81, P<0.01). The apA of patients were significantly decreased as controls (85.21° ± 12.09° and114.99° ± 10.88° , t=-10.27, P< 0.05). Conclusions Although in patients with pure T-wave inversion, even if the wall thickness of LV less than the apical hypertrophic cardiomyopathy diagnostic criteria, the LV morphological variations has apparently occurred. Therefore, these subjects may be included into a pre-clinical scope or a early stage of apical hypertrophic cardiomyopathy.