Correct!
4. Cardiac MR
Cardiac MR is the test of choice when myocarditis is suspected, and the patient’s young age, inflammatory markers, and the quality of her chest pain all suggest this diagnosis is more likely than an ischemic etiology, although the latter, including the possibility of spontaneous coronary artery dissection, remains. Catheter coronary artery angiography remains a consideration to evaluate for ischemic disease if myocarditis is excluded. Unenhanced and enhanced chest MR is typically not an ECG-gated examination and hence does not evaluate the heart as effectively as a dedicated cardiac MR examination and thus is not preferable in this situation. 18FDG-PET scan is potentially useful for suspected inflammatory disease but cannot evaluate the myocardium as effectively as cardiac MR. 68Ga scan has been used for diffuse pulmonary inflammatory disease but is not useful for myocardial evaluation.
The patient underwent cardiac MR (Figure 4).
Figure 4. Cardiac MR- selected images. Unenhanced (A) and enhanced (B) axial fast gradient-recalled echo images show the left lower lobe nodule (arrow); mild enhanced of the left lower lobe nodule was present (pre and post contrast signal intensity 164 and 262, respectively). C, short axis first-pass / perfusion image shows extensive circumferential hypointense subendocardial signal (arrowheads); such a distribution does not conform to a vascular territory. D, Short axis steady-state free precession imaging (a sequence that has some degree of T2-weighting and hence is fluid sensitive), shows increased circumferential subendocardial signal (arrowheads) similar in pattern and distribution to the first-pass sequence (C); this increased signal is accentuated on the 4-chamber fat saturation T2-weighted sequence (arrowheads, E). F, Short axis delayed / late gadolinium enhancement image shows no evidence of pericardial inflammation and no clearly significant myocardial enhancement. To view Figure 4 in a separate, enlarged window click here.
Which of the following statements regarding the cardiac MR examination is most accurate? (Click on the correct answer to be directed to the 6th of 17 pages)
