Myocarditis protocol (MRI)

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The cardiac MRI myocarditis protocol encompasses a set of different MRI sequences for the cardiac assessment in case of suspected myocardial inflammation.

Note: This article aims to frame a general concept of a cardiac MRI protocol in the above setting. 

Protocol specifics will vary depending on additional clinical questions, differential diagnosis, MRI scanner type, specific hardware and software, radiologist and perhaps referrer preference, patient factors e.g. arrhythmia or breathing problems or implants, specific indications and time constraints.

Indications

1.5 vs 3 tesla

Cardiac MRI examinations can be generally performed on both 1.5 and 3 tesla.

The cardiac MRI myocarditis protocol should be rather conducted on a system from which normal values for T1 mapping or T2 mapping are available.

The acquisition at 3 tesla requires a lot of adjustments and careful shimming to avoid flow and dark banding artifactsartefacts, especially concerning steady state-state free precessessionprecession cine imaging.

An applications application that may benefit from increased field strength is late gadolinium enhancement1,2.

Patient preparation

Checking indications, contraindications, explanation of the examination and obtaining informed consent is obvious as in other examinations. In case of a stress test there are certain issues which require consideration are explained specifically in that protocol.

Beyond that patient preparation for cardiac MRI includes the following:

·        

  • instruction how to breathe

    ·         an

  • an electrocardiogram signal need to be acquired

    ·         haemotocrit

  • haematocrit required for extracellular volume calculation

Patient positioning

A cardiac MRI is conducted in the supine position.

Technical parameters

Coil

Multi-phased-array coils are recommended.

·        

  • anterior surface coil

    ·        

  • cardiac coil
Scan geometry

·        

  • in-plane spatial resolution: will vary with the sequence

    ·        

  • field of view (FOV):  will vary, for most planes a FOV ≤320 mm is recommended

    ·        

  • slice thickness: varies with the sequence and is usually 6-10 mm
Planning

The cardiac planes differ from the normal axial, coronal and sagittal body planes 1-4:

Left ventricle
  • 4-chamber view (4ch) or horizontal long axis view

    ·        

    • angulation: along the left ventricular long axis through the apex and the centres of the mitral and tricuspid valves

      ·        

    • volume: including the anterior and inferior wall or a single slice
  • 2-chamber view (2ch) or left ventricular vertical long axis view

    ·        

    • angulation: along the left ventricular long axis through the left ventricular apex and the centre of the mitral valve

      ·        

    • volume: including septum and left ventricular free wall or single slice
  • 3-chamber view (3ch) or sagittal left ventricular outflow tract view (LVOT)

    ·        

    • angulation: through the left ventricular apex,  the centre of the mitral valve and the left ventricular outflow tract and aortic valve

      ·        

    • volume: including the anterolateral and inferoseptal left ventricular wall
  • short axis-axis view (sa(sax)

    ·        

    • angulation: perpendicularto the left ventricular long axis

      ·        

    • volume: stack usually including the atrioventricular valves and the cardiac apex or 3 single slices through basal, midventricular and apical zones

Cardiac examination modules

Anatomy
  • T1 or T2 black-blood or SSFP

    ·        

    • purpose: overview, a depiction of the cardiac surroundings and greats vessels, assessment ofevaluation for mediastinal lymphadenopathy in suspected cardiac sarcoidosis

      ·        

    • technique: T1 black-blood, T2 black-blood, SSFPideallyover 1-2 breathholds

      ·         breath-holds

    • planes: axial
Left ventricular function
  • Cinecine imaging

    ·        

    • purpose: left ventricular wall motion, left ventricular volumetry

      ·        

    • technique: cine SSFP or spoiled GRE

      ·        

    • planes: 2ch, 4ch, 3ch and short axis-axis views
Tissue characterization
  • T2 weighted imaging

    ·        

    • purpose: for the evaluation of myocardial oedema, myocardial haemorrhage, area at risk

      ·        

    • technique: STIR black-blood

      ·        

    • planes: short axis-axis view, 2ch* or 4ch*
  • T1 mapping*

    ·        

  • T2 mapping*

    ·        

    • purpose: cardiac tissue characterization (myocardial(myocardial oedema)

      ·        

    • technique: T2-TSE, T2p-SFFP, GraSE

      ·        

    • planes: short axis-axis views
Gadolinium enhancement
  • Latelate gadolinium enhancement

    ·        

    • purpose: for the evaluation of myocardial viability (myocadial(myocardial necrosis and myocardial scar tissue)

      ·        

    • technique: 2D and 3D IR GRE, PSIR

      ·        

    • planes: 2ch, 4ch, 3ch and short axis-axis views

      ·         TI

    • inversion time (TI) as determined by TI scout (Look Locker-Locker) or fixed TI (PSIR)

(*) indicates optional planes, sequences or modules

Practical points

The following considerations can be made in certain conditions:

·        

  • single shot-shot modules or free breathing with real time-time image acquisition in patients with difficulties to hold their breath

    ·        

  • abdominal bands in profound respiratory motion

    ·        

  • peripheral pulse gating in patientinpatient with a weak ECG signal

    ·        

  • postponing the exam in patients with severe pleural effusion and related ghosting artifactsartefacts and breathing problems until after pleural drainage
  • Cinecine imaging

    ·        

    • in atrial fibrillation or cardiac arrhythmia, it might be worthwileworthwhile to switch to prospective gating
  • T2 weighted imaging

    ·         short axis acquisitaion

    • short-axis acquisition with MRI integrated body coil (Q-body) only for assessment of myocardial oedema with T2 myocardium / skeletal muscle ratio, especially if no mapping is available 5
  • T1 mapping*

    ·        

    • for ECV calculationextracellular volume calculation dedicated postprocessing software is recommended

      ·        

    • for ECVextracellular volume calculation, haematocrit shoulshould be obtained aton the same day
  • Latelate gadolinium enhancement

    ·        

    • 2D IRGRE or sequences with SFFP readout in patients with poor breathholdingbreath-holding capabilities

      ·         increase TI

    • inversion time (TI) should be increased by 10ms every 1-2 minutes

      ·        

    • acquisition in mid or late diastole to minimize motion artefacts

      ·        

    • saturation bands across the spinal column and anterior chest wall can help to reduce ghosting artifactsartefacts
  • -<p>The<strong> cardiac MRI myocarditis protocol</strong>  should be rather conducted on a system from which normal values for T1 mapping or T2 mapping are available.</p><p>The acquisition at 3 tesla requires a lot of adjustments and careful shimming to avoid flow and dark banding artifacts especially concerning steady state free precessession cine imaging.</p><p>An applications that may benefit from increased field strength is late gadolinium enhancement <sup>1,2</sup>.</p><h4>Patient preparation</h4><p>Checking indications, contraindications, explanation of the examination and obtaining informed consent is obvious as in other examinations. In case of a stress test there are certain issues which require consideration are explained specifically in that protocol.</p><p>Beyond that patient preparation for cardiac MRI includes the following:</p><p><!--[if !supportLists]-->·         <!--[endif]-->instruction how to breathe</p><p><!--[if !supportLists]-->·         <!--[endif]-->an electrocardiogram signal need to be acquired</p><p><!--[if !supportLists]-->·         <!--[endif]-->haemotocrit required for extracellular volume calculation</p><h4>Patient positioning</h4><p>A cardiac MRI is conducted in the supine position.</p><h4>Technical parameters</h4><h5>Coil</h5><p>Multi-phased-array coils are recommended.</p><p><!--[if !supportLists]-->·         <!--[endif]-->anterior surface coil</p><p><!--[if !supportLists]-->·         <!--[endif]-->cardiac coil</p><h5>Scan geometry</h5><p><!--[if !supportLists]-->·         <!--[endif]-->in-plane spatial resolution: will vary with the sequence</p><p><!--[if !supportLists]-->·         <!--[endif]-->field of view (FOV):  will vary, for most planes a FOV ≤320 mm is recommended</p><p><!--[if !supportLists]-->·         <!--[endif]-->slice thickness: varies with the sequence and is usually 6-10 mm</p><p> </p><h5>Planning</h5><p>The <strong>cardiac planes</strong> differ from the normal axial, coronal and sagittal body planes <sup>1-4</sup>:</p><p>Left ventricle</p><p><strong>4-chamber view (4ch) or horizontal long axis view</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->angulation: along the left ventricular long axis through the apex and the centres of the mitral and tricuspid valves</p><p><!--[if !supportLists]-->·         <!--[endif]-->volume: including the anterior and inferior wall or a single slice</p><p><strong>2-chamber view (2ch) or left ventricular vertical long axis view</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->angulation: along the left ventricular long axis through the left ventricular apex and the centre of the mitral valve</p><p><!--[if !supportLists]-->·         <!--[endif]-->volume: including septum and left ventricular free wall or single slice</p><p><strong>3-chamber view (3ch) or sagittal left ventricular outflow tract view (LVOT)</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->angulation: through the left ventricular apex,  the centre of the mitral valve and the left ventricular outflow tract and aortic valve</p><p><!--[if !supportLists]-->·         <!--[endif]-->volume: including the anterolateral and inferoseptal left ventricular wall</p><p><strong>short axis view (sa)</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->angulation: perpendicular to the left ventricular long axis</p><p><!--[if !supportLists]-->·         <!--[endif]-->volume: stack usually including the atrioventricular valves and the cardiac apex or 3 single slices through basal, midventricular and apical zones</p><h4>Cardiac examination modules</h4><h5>Anatomy</h5><p><strong>T1 or T2 black-blood or SSFP </strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: overview, depiction of the cardiac surroundings and greats vessels, assessment of mediastinal lymphadenopathy in suspected sarcoidosis</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: T1 black-blood, T2 black-blood, SSFP ideally<strong> </strong>over 1-2 breathholds</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: axial</p><h5>Left ventricular function</h5><p><strong>Cine imaging</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: left ventricular wall motion, left ventricular volumetry</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: cine SSFP or spoiled GRE</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: 2ch, 4ch, 3ch and short axis views</p><h5>Tissue characterization</h5><p><strong>T2 weighted imaging</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: for the evaluation of myocardial oedema, myocardial haemorrhage, area at risk</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: STIR black-blood</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: short axis view, 2ch* or 4ch*</p><p> </p><p><strong>T1 mapping* </strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: cardiac tissue characterization (myocardial oedema, myocardial scar tissue)</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: MOLLI, ShMOLLI, SASHA, STONE, SAPPHIRE etc.</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: short axis views, 4ch or 2ch</p><p><strong>T2 mapping*</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: cardiac tissue characterization (myocardial oedema)</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: T2-TSE, T2p-SFFP, GraSE</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: short axis views</p><h5>Gadolinium enhancement</h5><p><strong>Late gadolinium enhancement</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->purpose: for the evaluation of myocardial viability (myocadial necrosis and myocardial scar tissue)</p><p><!--[if !supportLists]-->·         <!--[endif]-->technique: 2D and 3D IR GRE, PSIR</p><p><!--[if !supportLists]-->·         <!--[endif]-->planes: 2ch, 4ch, 3ch and short axis views</p><p><!--[if !supportLists]-->·         <!--[endif]-->TI as determined by TI scout (Look Locker) or fixed TI (PSIR)</p><h5>(*) indicates optional planes, sequences or modules</h5><h4>Practical points</h4><p>The following considerations can be made in certain conditions:</p><p><!--[if !supportLists]-->·         <!--[endif]-->single shot modules or free breathing with real time image acquisition in patients with difficulties to hold their breath</p><p><!--[if !supportLists]-->·         <!--[endif]-->abdominal bands in profound respiratory motion</p><p><!--[if !supportLists]-->·         <!--[endif]-->peripheral pulse gating in patient with a weak ECG signal</p><p><!--[if !supportLists]-->·         <!--[endif]-->postponing the exam in patients with severe pleural effusion and related ghosting artifacts and breathing problems until after pleural drainage</p><p><strong>Cine imaging</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->in atrial fibrillation or cardiac arrhythmia it might be worthwile to switch to prospective gating</p><p><strong>T2 weighted imaging</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->short axis acquisitaion with MRI integrated body coil (Q-body) only for assessment of myocardial oedema with T2 myocardium / skeletal muscle ratio, especially if no mapping is available <sup>5</sup></p><p><strong>T1 mapping* </strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->for ECV calculation dedicated postprocessing software is recommended</p><p><!--[if !supportLists]-->·         <!--[endif]-->for ECV haematocrit shoul be obtained at the same day</p><p><strong>Late gadolinium enhancement</strong></p><p><!--[if !supportLists]-->·         <!--[endif]-->2D IRGRE or sequences with SFFP readout in patients with poor breathholding capabilities</p><p><!--[if !supportLists]-->·         <!--[endif]-->increase TI 10ms every 1-2 minutes</p><p><!--[if !supportLists]-->·         <!--[endif]-->acquisition in mid or late diastole to minimize motion artefacts</p><p><!--[if !supportLists]-->·         <!--[endif]-->saturation bands across the spinal column and anterior chest wall can help to reduce ghosting artifacts</p>
  • +<p>The<strong> cardiac MRI myocarditis protocol</strong> encompasses a set of different <a href="/articles/mri-sequences-overview">MRI sequences</a> for the cardiac assessment in case of suspected myocardial inflammation.</p><p><em>Note: This article aims to frame a general concept of a cardiac MRI protocol in the above setting. </em></p><p><em>Protocol specifics will vary depending on additional clinical questions, differential diagnosis, MRI scanner type, specific hardware and software, radiologist and perhaps referrer preference, patient factors e.g. arrhythmia or breathing problems or implants, specific indications and time constraints.</em></p><h4>Indications</h4><ul>
  • +<li><a href="/articles/myocarditis">myocarditis</a></li>
  • +<li><a href="/articles/sarcoidosis-cardiac-manifestations-1">cardiac sarcoidosis</a></li>
  • +<li><a href="/articles/tako-tsubo-cardiomyopathy">Tako tsubo cardiomyopathy</a></li>
  • +<li><a href="/articles/minoca">myocardial infarction with non-obstructed coronary arteries (MINOCA)</a></li>
  • +</ul><h4>1.5 vs 3 tesla</h4><p>Cardiac MRI examinations can be generally performed on both 1.5 and 3 tesla.</p><p>The<strong> cardiac MRI myocarditis protocol </strong>should be rather conducted on a system from which normal values for <a href="/articles/t1-mapping-myocardium">T1 mapping</a> or <a href="/articles/t2-mapping">T2 mapping</a> are available.</p><p>The acquisition at 3 tesla requires a lot of adjustments and careful shimming to avoid flow and dark banding artefacts, especially concerning steady-state free precession cine imaging.</p><p>An application that may benefit from increased field strength is <a href="/articles/late-gadolinium-enhancement-2">late gadolinium enhancement</a> <sup>1,2</sup>.</p><h4>Patient preparation</h4><p>Checking indications, contraindications, explanation of the examination and obtaining informed consent is obvious as in other examinations.</p><p>Beyond that patient preparation for cardiac MRI includes the following:</p><ul>
  • +<li>instruction how to breathe</li>
  • +<li>an electrocardiogram signal need to be acquired</li>
  • +<li>haematocrit required for <a href="/articles/extracellular-volume-ecv-myocardium">extracellular volume</a> calculation</li>
  • +</ul><h4>Patient positioning</h4><p>A cardiac MRI is conducted in the supine position.</p><h4>Technical parameters</h4><h5>Coil</h5><p>Multi-phased-array coils are recommended.</p><ul>
  • +<li>anterior surface coil</li>
  • +<li>cardiac coil</li>
  • +</ul><h5>Scan geometry</h5><ul>
  • +<li>in-plane spatial resolution: will vary with the sequence</li>
  • +<li>field of view (FOV):  will vary, for most planes a FOV ≤320 mm is recommended</li>
  • +<li>slice thickness: varies with the sequence and is usually 6-10 mm</li>
  • +</ul><h5>Planning</h5><p>The <strong>cardiac planes</strong> differ from the normal axial, coronal and sagittal body planes <sup>1-4</sup>:</p><h6>Left ventricle</h6><ul>
  • +<li>
  • +<strong>4-chamber view (4ch) or horizontal long axis view</strong><ul>
  • +<li>angulation: along the left ventricular long axis through the apex and the centres of the mitral and tricuspid valves</li>
  • +<li>volume: including the anterior and inferior wall or a single slice</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>2-chamber view (2ch) or left ventricular vertical long axis view</strong><ul>
  • +<li>angulation: along the left ventricular long axis through the left ventricular apex and the centre of the mitral valve</li>
  • +<li>volume: including septum and left ventricular free wall or single slice</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>3-chamber view (3ch) or sagittal left ventricular outflow tract view (LVOT)</strong><ul>
  • +<li>angulation: through the left ventricular apex,  the centre of the mitral valve and the left ventricular outflow tract and aortic valve</li>
  • +<li>volume: including the anterolateral and inferoseptal left ventricular wall</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>short-axis view (sax)</strong><ul>
  • +<li>angulation: perpendicular to the left ventricular long axis</li>
  • +<li>volume: stack usually including the atrioventricular valves and the cardiac apex or 3 single slices through basal, midventricular and apical zones</li>
  • +</ul>
  • +</li>
  • +</ul><h4>Cardiac examination modules</h4><h5>Anatomy</h5><ul><li>
  • +<strong>T1 or T2 black-blood or SSFP </strong><ul>
  • +<li>purpose: overview, a depiction of the cardiac surroundings, evaluation for mediastinal lymphadenopathy in suspected <a href="/articles/sarcoidosis-cardiac-manifestations-1">cardiac sarcoidosis</a>
  • +</li>
  • +<li>technique: T1 black-blood, T2 black-blood, SSFP ideally<strong> </strong>over 1-2 breath-holds</li>
  • +<li>planes: axial</li>
  • +</ul>
  • +</li></ul><h5>Left ventricular function</h5><ul><li>
  • +<strong>cine imaging</strong><ul>
  • +<li>purpose: left ventricular wall motion, left ventricular volumetry</li>
  • +<li>technique: cine SSFP or spoiled GRE</li>
  • +<li>planes: 2ch, 4ch, 3ch and short-axis views</li>
  • +</ul>
  • +</li></ul><h5>Tissue characterization</h5><ul>
  • +<li>
  • +<strong>T2 weighted imaging</strong><ul>
  • +<li>purpose: for the evaluation of myocardial oedema, myocardial haemorrhage, area at risk</li>
  • +<li>technique: STIR black-blood</li>
  • +<li>planes: short-axis view, 2ch* or 4ch*</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>T1 mapping* </strong><ul>
  • +<li>purpose: cardiac tissue characterization (<a href="/articles/myocardial-oedema">myocardial oedema</a>, <a href="/articles/myocardial-fibrosis">myocardial fibrosis</a>, <a href="/articles/myocardial-scar-tissue">myocardial scar tissue</a>)</li>
  • +<li>technique: MOLLI, ShMOLLI, SASHA, STONE, SAPPHIRE etc.</li>
  • +<li>planes: short-axis views, 4ch or 2ch</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>T2 mapping*</strong><ul>
  • +<li>purpose: cardiac tissue characterization (<a href="/articles/myocardial-oedema">myocardial oedema</a>)</li>
  • +<li>technique: T2-TSE, T2p-SFFP, GraSE</li>
  • +<li>planes: short-axis views</li>
  • +</ul>
  • +</li>
  • +</ul><h5>Gadolinium enhancement</h5><ul><li>
  • +<strong>late gadolinium enhancement</strong><ul>
  • +<li>purpose: for the evaluation of myocardial viability (<a href="/articles/myocardial-necrosis">myocardial necrosis</a> and <a href="/articles/myocardial-scar-tissue">myocardial scar tissue</a>)</li>
  • +<li>technique: 2D and 3D IR GRE, PSIR</li>
  • +<li>planes: 2ch, 4ch, 3ch and short-axis views</li>
  • +<li>inversion time (TI) as determined by TI scout (Look-Locker) or fixed (PSIR)</li>
  • +</ul>
  • +</li></ul><p>(*) indicates optional planes, sequences or modules</p><h4>Practical points</h4><p>The following considerations can be made in certain conditions:</p><ul>
  • +<li>single-shot modules or free breathing with real-time image acquisition in patients with difficulties to hold their breath</li>
  • +<li>abdominal bands in profound respiratory motion</li>
  • +<li>peripheral pulse gating inpatient with a weak ECG signal</li>
  • +<li>postponing the exam in patients with severe pleural effusion and related ghosting artefacts and breathing problems until after pleural drainage</li>
  • +<li>
  • +<strong>cine imaging</strong><ul><li>in atrial fibrillation or cardiac arrhythmia, it might be worthwhile to switch to prospective gating</li></ul>
  • +</li>
  • +<li>
  • +<strong>T2 weighted imaging</strong><ul><li>short-axis acquisition with MRI integrated body coil (Q-body) only for assessment of myocardial oedema with T2 myocardium / skeletal muscle ratio, especially if no mapping is available <sup>5</sup>
  • +</li></ul>
  • +</li>
  • +<li>
  • +<strong>T1 mapping* </strong><ul>
  • +<li>for <a href="/articles/extracellular-volume-ecv-myocardium">extracellular volume</a> calculation dedicated postprocessing software is recommended</li>
  • +<li>for <a href="/articles/extracellular-volume-ecv-myocardium">extracellular volume</a> calculation, haematocrit should be obtained on the same day</li>
  • +</ul>
  • +</li>
  • +<li>
  • +<strong>late gadolinium enhancement</strong><ul>
  • +<li>2D IRGRE or sequences with SFFP readout in patients with poor breath-holding capabilities</li>
  • +<li>inversion time (TI) should be increased by 10ms every 1-2 minutes</li>
  • +<li>acquisition in mid or late diastole to minimize motion artefacts</li>
  • +<li>saturation bands across the spinal column and anterior chest wall can help to reduce ghosting artefacts</li>
  • +</ul>
  • +</li>
  • +</ul>

References changed:

  • 1. Kramer C, Barkhausen J, Bucciarelli-Ducci C, Flamm S, Kim R, Nagel E. Standardized Cardiovascular Magnetic Resonance Imaging (CMR) Protocols: 2020 Update. J Cardiovasc Magn Reson. 2020;22(1):17. <a href="https://doi.org/10.1186/s12968-020-00607-1">doi:10.1186/s12968-020-00607-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/32089132">Pubmed</a>
  • 2. Jo Y, Kim J, Park C et al. Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol. Korean J Radiol. 2019;20(9):1313. <a href="https://doi.org/10.3348/kjr.2019.0398">doi:10.3348/kjr.2019.0398</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31464111">Pubmed</a>
  • 3. Messroghli D, Moon J, Ferreira V et al. Clinical Recommendations for Cardiovascular Magnetic Resonance Mapping of T1, T2, T2* and Extracellular Volume: A Consensus Statement by the Society for Cardiovascular Magnetic Resonance (SCMR) Endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson. 2017;19(1):75. <a href="https://doi.org/10.1186/s12968-017-0389-8">doi:10.1186/s12968-017-0389-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28992817">Pubmed</a>
  • 4. Ferreira V, Schulz-Menger J, Holmvang G et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation. J Am Coll Cardiol. 2018;72(24):3158-76. <a href="https://doi.org/10.1016/j.jacc.2018.09.072">doi:10.1016/j.jacc.2018.09.072</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30545455">Pubmed</a>
  • 5. Friedrich M, Sechtem U, Schulz-Menger J et al. Cardiovascular Magnetic Resonance in Myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009;53(17):1475-87. <a href="https://doi.org/10.1016/j.jacc.2009.02.007">doi:10.1016/j.jacc.2009.02.007</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/19389557">Pubmed</a>

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  • cases

Systems changed:

  • Cardiac

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