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Case Reports
. 2021 Jun;8(3):2320-2327.
doi: 10.1002/ehf2.13276. Epub 2021 Mar 2.

Late gadolinium enhancement characteristics in giant cell myocarditis

Shujuan Yang  1 , Xiuyu Chen  1 , Jinghui Li  1 , Yang Sun  2 , Jialin Song  1 , Hongyue Wang  2 , Shihua Zhao  1
Affiliations
Case Reports

Late gadolinium enhancement characteristics in giant cell myocarditis

Shujuan Yang et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: This study aims to demonstrate the characteristics of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) imaging in patients with giant cell myocarditis (GCM).

Methods and results: Six patients histologically diagnosed with GCM were retrospectively recruited in this study. All of them underwent CMR during hospitalization. The distribution and extent of LGE were assessed on both ventricles, and the AHA-17 segment model was used for left ventricular (LV) analysis. Nine case reports with CMR in GCM were reviewed and summarized to investigate the features of LGE further. LGE was detected on both ventricular walls in all subjects. For a detailed analysis of LGE in the LV, the extent ranged from 21.6% to 56%. Among 70 segments (68.6%) involved by LGE, the subendocardial LGE was the most common pattern (46/102, including 24 segments located in the right-sided septum), followed by the subepicardial pattern (23/102). The right-sided septum, the subepicardial anterior wall, and the subendocardial right ventricular (RV) wall were observed in all subjects. To summarize the results of the present study with these case reports, the three most common patterns of LGE are the right-sided septum (73%), the subepicardial anterior wall (60%), and the subendocardial RV wall (53%).

Conclusions: Extensive LGE seems to be common in GCM, affecting both LV and RV walls. Apart from subepicardial LGE, subendocardial LGE, which was used to be implicated in ischaemic disease, was frequently presented in GCM. The right-sided subendocardial septum, the subepicardial anterior wall, and the subendocardial RV wall might be the vulnerable areas of LGE in GCM.

Keywords: Cardiovascular magnetic resonance; Giant cell myocarditis; Late gadolinium enhancement; Subendocardium.

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Conflict of interest statement

The authors report no relationship that could be construed as a conflict of interest.

Figures

Figure 1
Figure 1
Female, 51 years of age, presenting chest tightness for more than 1 year and syncope twice in 2 days (Case 4). Late gadolinium enhancement (LGE) images of the short‐axis (D), four‐chamber (C), and two‐chamber (E) views show enhancing area in the right ventricular (RV) wall, transmural and both‐sided LGE in the septum, transmural and epicardial LGE in the anterior wall, and epicardial LGE in the lateral and inferior walls (white arrows). Histopathologic findings show the transmural fibrosis in the RV free wall (A: Masson stain, ×40), anterior septum and anterior wall of left ventricle (G, Masson stain, ×100), and multinucleated giant cells in the anterior wall of left ventricle, septum (F: haematoxylin–eosin stain, ×200), and RV wall (B: haematoxylin–eosin stain, ×400). Black arrows indicate multinucleated giant cells, black circle indicates lymphocytic infiltrate, yellow rectangles indicate damaged myocardium, and red circles represent capillaries surrounded with lymphocytic infiltrates.
Figure 2
Figure 2
Four‐chamber view (left panel) and short‐axis view at the mid‐ventricular level (right panel) of late gadolinium enhancement images show the extensive enhancement predominantly involving the right‐sided septum and the anterior papillary muscle (arrows). Besides, there is a right ventricular apical thrombus (arrowheads).
Figure 3
Figure 3
Spatial distribution of the prevalence of segments involved by late gadolinium enhancement (blue), as well as subendocardial, subepicardial, and transmural late gadolinium enhancement (purple) in 17 segments of left ventricular myocardium, represented as bull's eye map.
Figure 4
Figure 4
The three most common late gadolinium enhancement patterns of giant cell myocarditis combined the present study with the case reports available: the right‐sided subendocardial septum (A), subepicardial anterior wall (B), and subendocardial RV wall (C). LV, left ventricle; RV, right ventricle.
See this image and copyright information in PMC

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