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J Am Coll Cardiol, 2006; 47:1649-1654, doi:10.1016/j.jacc.2005.11.067 (Published online 24 March 2006).
© 2006 by the American College of Cardiology Foundation
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Delayed Gadolinium-Enhanced Cardiac Magnetic Resonance in Patients With Chronic Myocarditis Presenting With Heart Failure or Recurrent Arrhythmias

Francesco De Cobelli, MD*,*, Maurizio Pieroni, MD, PhD{dagger},§, Antonio Esposito, MD*, Cristina Chimenti, MD, PhD{dagger},§, Elena Belloni, MD*, Renata Mellone, MD*, Tamara Canu, RT*, Gianluca Perseghin, MD{ddagger}, Carlo Gaudio, MD§, Attilio Maseri, MD{dagger}, Andrea Frustaci, MD§ and Alessandro Del Maschio, MD*

* Radiology Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy
{dagger} Cardio-Thoracic and Vascular Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy
{ddagger} Internal Medicine Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy
§ Department of Heart and Great Vessels "Attilio Reale," La Sapienza University Rome, Rome, Italy


Figure 1
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  		Figure 1 Patient with active myocarditis. Contrast-enhanced cardiac magnetic resonance short-axis imaging (A) shows a subepicardial late-enhancement stria in the posteroinferior left ventricular wall (arrows). (B) Left ventricular endomyocardial biopsy shows clusters of lymphocytic inflammatory infiltrates associated with necrosis of adjacent myocytes (hematoxylin and eosin, original magnification x400).

 

Figure 2
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  		Figure 2 Patient with borderline myocarditis. (A) In the TFE-inversion recovery T1-weighted long-axis four-chamber view, a mesocardial late-enhancement stria in the lateral medio-basal wall and small late-enhancement foci in interventricular septum are present. Long-axis two-chamber image (B) shows a mid-wall late-enhancement stria in the inferior medio-basal left ventricular wall. Left ventricular endomyocardial biopsy (C) showing sparse inflammatory infiltrates without myocyte necrosis indicating a borderline myocarditis (hematoxylin and eosin, original magnification x250).

 

Figure 3
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  		Figure 3 Different patterns of late enhancement. (A) TFE-inversion recovery T1-weighted images shows late-enhancement stria in right ventricular free wall (arrow) in a patient with active myocarditis involving both ventricles. (B) Contrast-enhanced cardiac magnetic resonance showing late-enhancement foci in the lateral wall in active myocarditis. (C) TFE-inversion recovery T1-weighted images showing a mid-wall late-enhancement stria located in the medial interventricular septum in a patient with heart failure and borderline myocarditis.

 




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