Citation, DOI & case data
Chest pain elevated troponin T: 1.4 µg/L, CK 19.2 µmol/L, LDH 6.3 µmol/L and C-reactive protein (CRP): 17 mg/L. Mildly decreased cardiac function on echo.
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Heart rate: 65 bpm, hematocrit: 0.42
Image quality: mild respiratory artifacts, otherwise no limitations
Morphology and functional analysis:
- LV-EDVI: 90 mL/m²
- LV-ESVI: 43 mL/m²
- LV-SVI: 46 mL/m²
- LV-EF: 52%
- cardiac output: 5.7 L/min
- cardiac index: 3.0 L/min/m²
- LV-ED wall + papillary mass: 77 g
- septum thickness: 8 mm
No regional left ventricular wall motion abnormalities.
Visually normal atrial size.
No significant cardiac valve pathology.
Cardiac tissue characterization (according to Lake Louise criteria II)1:
Regional myocardial edema is visible in the lateral wall from anterolateral to inferior and basal to apical.
Subepicardial and patchy intramyocardial late gadolinium enhancement (LGE) visible in the lateral and inferior segments from basal to apical.
T2 mapping: 65-70 ms [42-56 ms*]
* native reference range based on local data
Minimal pericardial enhancement without thickening, adjacent to the left ventricular free wall.
No pericardial effusion.
Small bilateral pleural effusions.
1 case question available
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Focal myocardial edema can be seen in the lateral and inferior segments from basal to apical (blue arrowheads).
Myocardial edema can be also assessed by calculating the T2 signal intensity ratio between myocardium and skeletal muscle within the same image.
Increased native T1 in the basal, midventricular and apical lateral and inferior segments is measured and displayed on a color-map T1 >1150 ms, z-score of >5 (based on local data).
The T1 values in the septum are within normal limits of the local reference range.
Increased T2 values are measured in the basal, midventricular and apical lateral and inferior wall as another proof of myocardial edema in those segments.
The T2 values in the septum are within normal limits of the local reference range.
Patchy intramyocardial and focal subepicardial late gadolinium enhancement can be seen on IR-GE images (red arrowheads) which is a characteristic pattern in myocarditis and reflects myocardial injury or myocardial necrosis but is neither very sensitive nor specific if used exclusively 2.
3 case questions available
According to the Lake Louise criteria, both main criteria are fulfilled 2:
- myocardial edema (based on T2w images or T2 mapping)
- non-ischemic myocardial injury (abnormal native T1, ECV or LGE)
In addition, there is mild systolic dysfunction present, which further supports the diagnosis and accounts as one of the supportive criteria (pericarditis, systolic dysfunction).
- 1. Treibel T, White S, Moon J. Myocardial Tissue Characterization: Histological and Pathophysiological Correlation. Curr Cardiovasc Imaging Rep. 2014;7(3):9254. doi:10.1007/s12410-013-9254-9 - Pubmed
- 2. Ferreira V, Schulz-Menger J, Holmvang G et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol. 2018;72(24):3158-76. doi:10.1016/j.jacc.2018.09.072 - Pubmed
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