The importance of cardiac MRI as a diagnostic tool in viral myocarditis-induced cardiomyopathy

Added value of cardiac magnetic resonance in etiological diagnosis of ventricular arrhythmias

“…15 Although its disadvantages are also recognized, particularly its inability to diagnose special forms of myocarditis such as giant cell or eosinophilic myocarditis, which require specific therapies, CMR can help determine long-term prognosis and stratify risk of potentially fatal events, including ventricular arrhythmias. 16 Arrhythmogenic right ventricular dysplasia/arrhythmogenic cardiomyopathy: The superior ability of CMR to assess the dimensions and function of the right ventricle was recognized in the 2010 revision of the diagnostic criteria for arrhythmogenic right ventricular dysplasia/arrhythmogenic cardiomyopathy, 12 with CMR reference values being incorporated into the criteria, unlike the original criteria published in 1994, which were based on symptomatic index cases with relatively advanced disease and were thus less sensitive for detection of early stages of the disease. 17 However, histological demonstration of fibrofatty accumulation at biopsy remains necessary, and CMR T1-weighted images are still considered non-specific.…”

Evaluation of hypertrophic cardiomyopathy: new horizons for CMR?

“…10 The affected areas included papillary muscles (sarcoid), the mid-myocardium (Anderson-Fabry disease, glycogen storage disease, myocarditis, Becker and Duchenne muscular dystrophy) and the global subendocardium (systemic sclerosis, Loeffler's endocarditis, amyloid, Churg-Strauss). 11 In these specific cardiomyopathies, a typical pattern of late gadolinium enhancement can be found which is overtly distinct from the enhancement patterns seen in myocardial infarction. [12][13][14][15][16][17][18] In an interesting review article in the current issue of the Netherlands Heart Journal, Germans et al 19 address the clinical applicability of CMR to determine the underlying cause of different forms of LVH, in particular in patients with HCM.…”

Myocarditis mimicking acute coronary syndrome: the role of cardiac magnetic resonance imaging and immunoglobulin therapy

“…Contrast-enhanced cardiac magnetic resonance is promising for the early diagnosis of acute myocarditis [9]. A combined CE-CMR protocol using 3 major diagnostic criteria is recommended.…”

“…This early enhancement suggests hyperemia and capillary leakage related to inflammation. Late gadolinium enhancement reflects incomplete washout from the myocardium late after the injection and indicates irreversible myocardial injury [9,10]. A recent retrospective study demonstrated that late gadolinium enhancement was associated with a poor outcome in pediatric patients (mean age, 10.5 years) with myocarditis [11].…”

“…A recent retrospective study demonstrated that late gadolinium enhancement was associated with a poor outcome in pediatric patients (mean age, 10.5 years) with myocarditis [11]. Enhancement of the epicardial layers is associated with inflammation because of myocarditis, in contrast to ischemic myocardial inflammation, which primarily involves the subendocardium [9].…”