Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis

Figure 1. Images of patient with myocarditis. Three chamber and basal short-axis images of a patient with myocarditis displaying patchy posterolateral late gadolinium enhancement (LGE) (white regions, arrowed) that correspond to oedematous regions of myocardium on the T2 map (lighter regions, arrowed). There is no uptake of ultrasmall superparamagnetic particles of iron oxide (USPIO) in the post-USPIO R2* maps; corresponding regions may even have lower R2* in this patient. Myocardial oedema appears to normalise but subtle LGE remains at 3 months.

Figure 2. Myocardial USPIO enhancement vs Oedema at Baseline. Changes in myocardial R2* due to USPIO accumulation (A, left) and myocardial oedema by T2 mapping (B, right) are shown in healthy volunteers (HV) and patients with myocarditis (M) using panmyocardial average, and further limited to regions displaying LGE in patients with myocarditis (M LGE+). There were no significant differences in ΔR2* due to USPIO accumulation between all groups (p>0.05 for all). There was no difference in panmyocardial T2 between volunteers with patients with myocarditis. Myocardial regions displaying LGE (M LGE+) had greater T2 than the panmyocardial value for healthy volunteers and myocarditis patients (****p<0.0001 and **p<0.01 respectively).

Figure 3. Changes on repeat imaging at 3 months in patients with myocarditis. There was no significant (ns) difference in ultrasmall superparamagnetic particles of iron oxide uptake between baseline and 3 months in both panmyocardium (A) and in regions displaying late gadolinium enhancement (LGE) (B). There was no difference in panmyocardial T2 (C) over 3 months. T2 in regions displaying LGE (D) reduced, as did the volume of LGE (E) over the 3-month period. There was an increase in ejection fraction (EF) between baseline and 3 months (F); *p<0.05.