Cover Image: Evaluation of diagnosis and course of myocarditis by MRI
Andreas Hans Fischer, Thomas F. Luscher, and Juerg Schwitter
Department of Cardiology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland
A 60-year-old patient with suspected subacute myocardial infarction was referred for coronary angiography. Two days prior to admission, the physically fit gentleman had a sudden onset of dyspnoea on effort according to NYHA III. The resting ECG showed ST-elevations in inferior and lateral leads (see Figure: Acute), and both creatinine kinase and troponin T were elevated with 982 U/L and 2.42 µg/L, respectively (normal values: <190 and <0.10, respectively). Angiography revealed normal coronary arteries. Left ventricular function showed slight apical hypokinesis with globally preserved function. Delayed-enhancement magnetic resonance imaging (MRI) demonstrated multiple subepicardial and mid-myocardial focal enhancement of the apex consistent with myocarditis. A treatment with ACE inhibitors was initiated and the patient recovered well. After 3 months, the signs of myocarditis in the MRI follow-up study had disappeared and ECG had normalized (F/u). Contrast media enhanced MRI is a powerful non-invasive diagnostic tool for the detection and monitoring of myocarditis.
Figure legend
Panels A–D: MRI study at baseline demonstrate s slight apical hypokinesis in end-systolic phase (arrows in D, C = end-diastolic phase). In A and B, short-axis delayed-enhanced MR images show multiple foci in the subepicardium and the midwall (arrows in A and B) and the acute ECG shows ST-elevation (arrows). At 3-months follow-up (E–H), systolic function normalized (G and H) and delayed-enh ancement demonstrates resolution of inflammatory foci (E and F, identical location as in A and B) along with ECG normalization (F/u).
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