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Myocardial edema and necrosis in a patient with acute myocarditis

Case Study
Gebker, Rolf, M.D., Ph.D. German Heart Institute Berlin • Germany

Patient history

24-year-old male with new onset chest pain for 12 hours, ubiquitous changes of the ST-segment and elevated troponin levels. Immediately performed invasive angiography, did not demonstrate any obstructive coronary disease. CMR was carried out the day after admission to our hospital.

MR examination

Ingenia 3.0T with Anterior and integrated Posterior coils was used for a typical CMR exam using cine B-FFE, T2-weighted imaging and contrast-enhanced images for tissue characterization.
Breath hold was about 8-12 seconds.
Spatial resolution was between 1.5 x 1.5 and 2.0 x 2.0 mm.

 

The ExamCard used was the non-ischemic cardiomyopathy module, which is identical to a myocarditis protocol. It can be found in:

Ingenia 3.0T Cardiac Exam Cards according to the SCMR guidelines

MR images and interpretation

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The cine B-FFE movie demonstrates a slightly depressed global LV-function with subtle regional wall motion abnormalities.

T2-weighted
T2-weighted
Late enhancement
Late enhancement
Late enhancement
Late enhancement

T2-weighted images and late gadolinium enhancement show diffuse, epicardially pronounced evidence of edema and myocardial necrosis (white arrows).

Diagnosis

Acute myocarditis

Clinical impact of CMR imaging

CMR provides excellent methods for quantification of cardiac function and volumes as well as tissue characterization for the identification of myocardial edema and necrosis.


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Dec 4, 2012

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Case Study
Ingenia 3.0T
Release 4
Cardiac, cmr, Function Cine, Mycardial edema
 

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