Annotated image - Key findings
T2BB 4ch / STIR sa
Early gadolinium enhancement
Late gadolinium enhancement (LGE)
T1 mapping
T2 black-blood / short tau inversion recovery (STIR) imaging:
Focal myocardial oedema can be seen in the apical and mid free lateral wall on T2 black-blood images (blue arrowheads) and not so obvious in the STIR images (blue arrows). It can be visualized with a colour map.
Myocardial oedema can be also assessed by calculating the T2 signal intensity ratio between myocardium and skeletal muscle within the same image 1,2.
In this case, the T2 ratio was 2.3 - a T2 ratio of ≥2 is considered abnormal, provided images were acquired with the MRI integrated body coil (Q-body) 2-4.
Early gadolinium enhancement:
Myocardial hyperaemia/capillary leakage can be assessed in T1 black-blood SE images by calculating myocardial early gadolinium enhancement (EGE) ratio 2-4.
The enhancement ratio between myocardium and skeletal muscle, in this case, is ≥7 and absolute myocardial enhancement ≥60%. An enhancement ratio of ≥4 is considered and 45% is considered abnormal, again provided that images were acquired with the MRI integrated body coil (Q-body) 2-4.
Late gadolinium enhancement (LGE):
Patchy intramyocardial and focal subepicardial late gadolinium enhancement can be seen on IR-GE images (red arrowheads) and on short-axis PSIR images (arrows), which is a characteristic pattern in myocarditis5 and reflects myocardial injury, but is neither a very sensitive nor specific feature if used exclusively1-5.
T1 mapping native and postcontrast:
Increased native T1 in the antero- and inferolateral midventricular segments is measured and displayed on a colour-map T1 >1150 ms, z-score of >5 (based on local data).
The application of gadolinium leads to a shortening of T1 and even more so in the inflamed segments of the myocardium, which can be appreciated especially in the lateral wall.
Extracellular volume (ECV) was 32-35% in the antero- and inferolateral midventricular segments.