Delayed contrast-enhanced magnetic resonance imaging for the detection of autoimmune myocarditis and long-term follow-up.
MRI proved to be a valuable tool for the evaluation and monitoring of myocarditis. We report the case of a 36 year old caucasian male with an undifferentiated collagenosis who presented first four years ago with unspecific symptoms and impaired exercise capacity. On echocardiography left ventricular function was impaired as well as on MRI. In addition, after administration of Gd-DTPA an intramyocardial pathological signal enhancement was observed on TSE T1 weighted and contrast enhanced FLASH 3D IR sequences. Based on several diagnostic tests including myocardial biopsy an autoimmune myocarditis due to an undifferentiated collagenosis was diagnosed. On long time follow up over almost 3 years with repeated MRI examinations, the delayed hyper enhancement (dHE) decreased or disappeared with successful treatment, respectively. However, in the area of recurrent inflammation, a persisting area of dHE developed with a subsequent perfusion defect. This area represents myocardial fibrosis due to recurrent inflammation.
Dill
Thorsten
T
Department of Cardiology/Cardiovascular Imaging, Kerckhoff Heart Center, Bad Nauheim, Germany. t.dill@kerckhoff-klinik.de
Ekinci
Okan
O
Hansel
Jochen
J
Kluge
Alexander
A
Breidenbach
Christiane
C
Hamm
Christian W
CW
D000328:Adult; D003095:Collagen Diseases / Q000150:complications; D003287:Contrast Media; D005355:Fibrosis / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000209:etiology; D009206:Myocardium / Q000473:pathology
D003287:Contrast Media; D019786:Gadolinium DTPA