Noninvasive Imaging in Myocarditis
Hadi N. Skouri, MD*,
G. William Dec, MD, FACC ,
Matthias G. Friedrich, MD, FESC and
Leslie T. Cooper, MD, FACC*,*
* Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
Stephenson CMR Centre, University of Calgary, Calgary, Alberta, Canada
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Figure 1 Antimyosin cardiac imaging for detection of acute myocarditis. A positive antimyosin image shows diffuse uptake in the cardiac region on both the anterior planar (A) and in all coronal tomographic reconstructions (B) (arrows). Biopsy confirmed multifocal lymphocytic myocarditis. L = liver. Reprinted with permission of G. W. Dec, MD.
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Figure 2 Short-axis cardiac magnetic resonance images of the same anatomical regions with pathological findings in a patient with acute myocarditis. (Upper row, left) Steady-state free precession images in diastole (left) and systole (right), showing anterior hypokinesis (arrow) and a small pericardial effusion. (Upper row, right) Triple-inversion-recovery prepared T2-weighted spin echo image showing regional edema of the anteroseptal, anterior, anterolateral, and inferior segments with predominant subepicardial involvement. (Lower row, left) T1-weighted fast spin echo images before (left) and after (right) application of gadolinium. Note the diffuse signal intensity increase. The quantitative evaluation showed a pathological signal change. (Lower row, right) T1-weighted inversion-recovery prepared gradient echo image obtained 5 min after application of gadolinium. There are extensive areas with high signal intensity (late enhancement), predominantly involving subepicardial regions (arrows). A small artifact is noted, which should not be interpreted as pathology.
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Figure 3 Inversion-recovery prepared T1-weighted gradient echo images with typical late enhancement patterns in a patient with chronic myocarditis. (Left) Short-axis view with "midwall sign" (arrows), which likely represents fibrosis of the longitudinal myocardial fibers in the septum. (Right) Four-chamber view with patchy late enhancement areas with predominant subepicardial, mainly lateral distribution (arrows).
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Figure 4 Patient with edematous myocarditis, but lack of irreversible injury. (Left) T2-weighted image showing diffuse edema, mainly of the inferolateral segment. (Right) Late enhancement image with lack of high signal intensity areas. LAX = long axis; SAX = short axis.
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