I mmune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) is one of the most serious immunotherapy-related toxicities (1)(2)(3)(4). By reactivating the immune response against a tumor, ICIs can lead to numerous immune-related adverse events, including ICI-M. Although this cardiovascular event is uncommon, the case fatality rate is high, at approximately 30%-50%, and early administration of corticosteroids is required to improve the prognosis (5-7). We need better knowledge of the features of this emerging cardiovascular disease to modify the management of patients.Endomyocardial biopsy (EMB) is the reference standard for the diagnosis of myocarditis but is not systematically used because of its potential complications and low sensitivity (8). Cardiac MRI is now considered the best noninvasive imaging modality for the diagnosis of non-ICI-induced myocarditis based on the updated 2018 Lake Louise (2018-LL) criteria, which help identify myocardial abnormalities, including global or regional nonischemic injury and edema (9). In addition, cardiac MRI has prognostic value based on late gadolinium enhancement (LGE) presence, localization, and pattern (10-12). Very little data exist on cardiac MRI findings and their predictive value in ICI-M. Recently, two retrospective studies investigated the Background: Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer. Purpose:To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE). Materials and Methods:In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] z scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored.Results: Thirty-three patients with ICI-M (mean age 6 standard deviation, 68 years 6 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years 6 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years 6 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 z scores (0.03 6 0.85 vs 1.79 6 1.93 [P , .001]; 1.34 6 0.57 vs 2.59 6 1.97 [P = .03]; and 20.76 6 1.41 vs 0.88 6 1.96 [P = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; P , .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; P , .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; P , .001) and midwall layer (11 of 33 patients [33%] vs two of 85...

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Background Prostatic artery embolization (PAE) is associated with patients’ quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. Main text This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. Conclusions This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.

Background Heart failure- (HF) and arrhythmia-related complications are the main causes of morbidity and mortality in patients with nonischemic dilated cardiomyopathy (NIDCM). Cardiovascular magnetic resonance (CMR) imaging is a noninvasive tool for risk stratification based on fibrosis assessment. Diffuse interstitial fibrosis in NIDCM may be a limitation for fibrosis assessment through late gadolinium enhancement (LGE), which might be overcome through quantitative T1 and extracellular volume (ECV) assessment. T1 and ECV prognostic value for arrhythmia-related events remain poorly investigated. We asked whether T1 and ECV have a prognostic value in NIDCM patients. Methods This prospective multicenter study analyzed 225 patients with NIDCM confirmed by CMR who were followed up for 2 years. CMR evaluation included LGE, native T1 mapping and ECV values. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE) which was divided in two groups: HF-related events and arrhythmia-related events. Optimal cutoffs for prediction of MACE occurrence were calculated for all CMR quantitative values. Results Fifty-eight patients (26%) developed a MACE during follow-up, 42 patients (19%) with HF-related events and 16 patients (7%) arrhythmia-related events. T1 Z-score (p = 0.008) and global ECV (p = 0.001) were associated with HF-related events occurrence, in addition to left ventricular ejection fraction (p < 0.001). ECV > 32.1% (optimal cutoff) remained the only CMR independent predictor of HF-related events occurrence (HR 2.15 [1.14–4.07], p = 0.018). In the arrhythmia-related events group, patients had increased native T1 Z-score and ECV values, with both T1 Z-score > 4.2 and ECV > 30.5% (optimal cutoffs) being independent predictors of arrhythmia-related events occurrence (respectively, HR 2.86 [1.06–7.68], p = 0.037 and HR 2.72 [1.01–7.36], p = 0.049). Conclusions ECV was the sole independent predictive factor for both HF- and arrhythmia-related events in NIDCM patients. Native T1 was also an independent predictor in arrhythmia-related events occurrence. The addition of ECV and more importantly native T1 in the decision-making algorithm may improve arrhythmia risk stratification in NIDCM patients. Trial registration NCT02352129. Registered 2nd February 2015—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02352129