Role of cardiac magnetic resonance imaging in troponinemia syndromes

Table 1 Cardiac magnetic resonance imaging features

Condition	Cardiac magnetic resonance imaging features
Myocardial infarction	< 1 mo
	Myocardial oedema present on T2-weighted images, T2 mapping and T1 mapping
	Microvascular obstruction revealed as a hypointense core within hyperintense infarct zone in area of LGE
	Infarct size can be calculated using pre and post-contrast T1-weighted mapping and ECV assessment
	Myocardial necrosis/scar by LGE in a subendocardial or full-thickness pattern within a coronary artery territory
	Additionally at < 6 mo
	T2-weighted hyperintensity on double inversion recovery turbo spin echo
Takotsubo syndrome	Can help distinguish coexisting CAD or acute myocarditis LGE typically absent
	Myocardial oedema present on T2-weighted images, T2 mapping and T1 mapping
	Accurate assessment of WMAs on cine imaging
	Can be useful to identify ventricular thrombus
Myocarditis	Inflammatory hyperaemia demonstrated on T1-weighted images
	Myocardial oedema on T2-weighted images
	Myocardial necrosis/scar by LGE in a subepicardial or mid-wall pattern
	Greater T1 and T2 increases with acute inflammation
	Pericardial effusion
COVID-19 related cardiac dysfunction	Features similar to that of acute myocarditis
	Myocardial oedema on T2-weighted images
	Myocardial necrosis/scar by LGE in a subepicardial or mid-wall pattern
	Myocardial fibrosis using T1-weighted mapping and ECV assessment
	Can be useful to identify ventricular thrombus and pericardial effusion
Athlete’s heart	LVH typically < 12 mm
	Lower ECV with LVH compared to HCM
	RV dilatation seen on cine imaging
	LGE focal and generally at the RV insertion points

LGE: Late gadolinium enhancement; ECV: Extra-cellular volume; CAD: Coronary artery disease; WMAs: Wall motion abnormalities; LVH: Left ventricular hypertrophy; HCM: Hypertrophic cardiomyopathy; RV: Right ventricular; COVID-19: Coronavirus disease 2019.

Table 2 Lake Louise consensus criteria for myocarditis on cardiac magnetic resonance imaging

Two out of three criteria must be met to be consistent with myocardial inflammation:

Regional or global myocardial signal intensity increase in T2-weighted images

Increased global myocardial early gadolinium enhancement ratio between myocardium and skeletal muscle in gadolinium-enhanced T1-weighted images

At least one focal lesion with nonischaemic regional distribution in inversion recovery-prepared gadolinium enhanced T1-weighted images (late gadolinium enhancement)