PMC9091656_01
Representative 4-Chamber (4CH) view images of late gadolinium enhancement (LGE). A comparison between LGE images from the past bout of myocarditis (A,B) and the current acute phase (C). LGE is comparable and restricted to the subepicardial regions, particularly in the inferolateral and apical myocardial segments. Arrows indicate areas of LGE.
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F1
Considering the medical history of the patient, images from the CMR scan during the earlier bout of myocarditis (Figures 1A,B) were compared to the present (Figure 1C).
Representative native T1 mapping image and the corresponding late gadolinium enhancement (LGE) image at presentation. (A) Midventricular short axis image of T1 map (SAX) showing elevation of the T1 times; an example from the inferoseptal segment (demarcated green area: 1,305 ms). (B) Bullseye plot showing the native T1-times. Segmentation was performed according to the AHA 16-segment model. Native T1 times were increased in all segments irrespective of the presence/absence of LGE. (C) Corresponding mid-ventricular SAX LGE image without evidence of LGE. Normal T1 Mapping values for a 3 Tesla MRI <1,228 ms (1,181 +- 47 ms).
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F2
T1 mapping indices in the mid-ventricular myocardial inferoseptal segment has been shown in Figure 2, although there is no evidence of any LGE in this segment.
Representative native T1 mapping image and the corresponding late gadolinium enhancement (LGE) image at follow up after 3 months. (A) Midventricular short axis image (SAX) of T1 map showing normal T1 times at follow up; an example from the inferoseptal segment (demarcated green area: 1,208 ms) (B) Bullseye plot showing the native T1-times. Segmentation was performed according to the AHA 16-segment model. Native T1 times show a return to baseline at follow-up except for values in apical myocardium which correspond to the residual scar tissue reflecting chronic myocarditis (C) Corresponding mid-ventricular SAX LGE image still without evidence of LGE.
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F3
T1 mapping indices had normalized (1,194 ms) except for myocardial segments corelating to chronic myocarditis (also evident in past CMR images) (Figure 3).