"Myocarditis" - Case-Based Webinar (CME)-Video

Video Transcription

Video Summary

The webinar was a case-based educational session on cardiovascular magnetic resonance (CMR) in myocarditis, organized by SEMR. The presenters emphasized that CMR is the key noninvasive tool for identifying myocardial inflammation, fibrosis, edema, and disease activity, and that myocarditis can present in many settings beyond viral infection, including systemic disorders, Takotsubo syndrome, sarcoidosis, and MINOCA.<br /><br />Jeanette Schulz-Menger reviewed the updated Lake Louise criteria and explained the roles of T2 imaging/mapping for edema and active inflammation, T1 mapping for myocardial injury/fibrosis, and late gadolinium enhancement (LGE) for focal scar. She stressed that no single sequence is enough; interpretation must combine clinical history, cine function, edema imaging, and LGE. She also noted practical issues such as vendor-specific normal values, limitations in arrhythmia or thin walls, and the need to image the full ventricle, especially in children.<br /><br />Three cases were presented:<br />1. A young woman with COVID-19, chest pain, and high troponin had normal function but focal subepicardial edema and LGE, consistent with acute myocarditis.<br />2. A 40-year-old woman with fever, dyspnea, and severe LV dysfunction had diffuse edema, elevated T1/T2, pericardial effusion, and diffuse LGE, supporting active myocarditis.<br />3. A 35-year-old man with chest pain and very high troponin had edema plus a subendocardial scar pattern and borderline ECV, leading to a diagnosis of MINOCA rather than classic myocarditis.<br /><br />The session ended with Q&A on mapping values, follow-up timing, differentiating myocarditis from amyloidosis, sarcoidosis, and Takotsubo, and the importance of using the full CMR protocol.

Keywords

cardiovascular magnetic resonance

CMR

myocarditis

Lake Louise criteria

T1 mapping

T2 imaging

late gadolinium enhancement

myocardial inflammation

MINOCA

cardiac imaging