Multiparametric assessment of myocarditis using simultaneous positron emission tomography/magnetic resonance imaging

A 19-year-old man presented with general malaise, retrosternal chest pain, and palpitations. ECG demonstrated a flattening of T-waves in pre-cordial leads. Laboratory measurements showed elevated troponin I (6.6 ng/mL) and creatine kinase (477 U/L). Histopathological analysis of three samples taken from the right ventricle (RV) via endomyocardial biopsy (EMB) was unsuspicious, but polymerase chain reaction revealed DNA of parvorvirus B19. Simultaneous PET/MRI with 18F-fluorodeoxyglucose (FDG) was performed (Biograph mMR, Siemens, Germany). Myocardial glucose uptake was suppressed with high-fat-low-carbohydrate diet and i.v. administration of unfractionated heparin (50 IU/kg) 15 min before the FDG injection. Cine imaging showed normal left ventricular (LV) function. No pericardial effusion was found. T2-weighted images revealed an oedema in the LV anterior wall (Panel C). Dynamic perfusion imaging revealed hyperaemia in the LV anterior wall (Panel D). Subepicardial late gadolinium-enhancement (LGE; Panel A) was found in the LV anterior wall that was in excellent agreement with increased FDG uptake (Panel B).