title: The utility of cardiac magnetic resonance imaging in Kounis syndrome.
abstract: BACKGROUND
  Current diagnostic measurements used to assess myocardial involvement in Kounis syndrome, such as electrocardiography (ECG), cardiac enzymes, and troponin levels, are relatively insensitive to small but potentially significant functional change. According to our review of the literature, there has been no study using magnetic resonance imaging (MRI) on Kounis syndrome except for one case report.
  
  
  OBJECTIVE
  To identify the findings of dynamic contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with Kounis syndrome (KS) type 1.
  
  
  METHODS
  We studied 26 patients (35 ±11.5 years, 53.8% male) with known or suspected KS type 1. The patients underwent precontrast, first-pass, and delayed enhancement cardiac MRI (DE-MRI). Contrast enhancement patterns, edema, hypokinesia, and localization for myocardial lesions were evaluated in all KS type 1 patients.
  
  
  RESULTS
  Contrast-enhanced magnetic resonance imaging demonstrated an early-phase subendocardial contrast defect, and T2-weighted images showed high-signal intensity consistent with edema in lesion areas. None of the lesion areas was found upon contrast enhancement on DE-MRI. The area of early-phase subendocardial contrast defect was reported as follows: the interventricular septum in 14 (53.8%) patients, the left ventricular lateral wall in 8 (30.7%), and the left ventricular apex in 4 (15.4%).
  
  
  CONCLUSIONS
  Dynamic cardiac MR imaging is a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type 1.
authors.affiliation: Department of Radiology, School of Medicine, Bozok University, Yozgat, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Okur
authors.affiliation: Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Mecit
authors.initials: M
authors.lastname: Kantarci
authors.affiliation: Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Leyla
authors.initials: L
authors.lastname: Karaca
authors.affiliation: Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Hayri
authors.initials: H
authors.lastname: Ogul
authors.affiliation: Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Aköz
authors.affiliation: Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Kızrak
authors.affiliation: Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Sahin
authors.initials: S
authors.lastname: Aslan
authors.affiliation: Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Berhan
authors.initials: B
authors.lastname: Pirimoglu
authors.affiliation: Department of Cardiology, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Enbiya
authors.initials: E
authors.lastname: Aksakal
authors.affiliation: Department of Emergency Medicine, School of Medicine, Ataturk University, Erzurum, Turkey.
authors.forename: Mucahit
authors.initials: M
authors.lastname: Emet
keywords: Kounis syndrome; cardiac magnetic resonance imaging; hypersensitivity