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Table 1 Information provided by various CMR techniques applied in the evaluation of acute myocarditis, with main imaging features

From: Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis

CMR technique Information provided Imaging features
Cine-SSFP Regional and global biventricular function, ventricular mass, and parietal wall thickness - Normal or mildly dilated left or biventricular cavities
- Ejection fraction depending on clinical presentation, usually mildly depressed (45–50 %)
- Parietal wall thickness normal or slightly increased (>10 mm)
- Pericardial effusion in 30–50 % of cases
T2w-STIR Increased myocardial free water content - Subepicardial or patchy areas of high signal intensity following LGE distribution
- Global hyperintensity compared to skeletal muscle (T2 ratio > 1.9 according to LLc)
Pre- and post-Gd T1w FSE Myocardial hyperemia and expansion of extracellular compartment - Sequences frequently affected by severe artefacts
- Myocardial hyper-enhancement compared to skeletal muscle (EGEr > 4 according to LLc)
Delayed enhancement Myocardial necrosis, scars - No enhancement
- Focal subepicardial enhancement typically involving inferolateral LV wall
- Patchy or longitudinal striae of mid-wall enhancement
Native T1 mapping Pixel-by-pixel assessment of T1-rt revealing myocardial changes, first of all oedema - T1-rt prolongation: proposed cut-off > 990 ms (59)
Pre- and post-Gd T1 mapping ECV expansion due to enhanced diffusion of free water and cardiomyocyte apoptosis - ECV increase: proposed cut-off ≥ 27 %; still few published data (34)
T2 mapping Pixel-by-pixel assessment of T2-rt revealing myocardial oedema - T2-rt prolongation; still few published data (64)
  1. CMR cardiovascular magnetic resonance, SSFP steady-state free precession, T2w-STIR T2-weighted short-tau inversion recovery, FSE fast spin echo, Gd gadolinium, T1-rt T1 relaxation time, ECV extracellular volume, T2-rt T2 relaxation time, LGE late gadolinium enhancement, LLc Lake Louise criteria, EGEr early gadolinium enhancement ratio, LV left ventricle