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Wonderful. Thank you so much for the invitation to be

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here at today. And thank you all for joining. I mentioned

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we're going to go through a couple cases at the

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beginning and then we'll have a bit of a review to summarize

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some of the findings but I'm happy to address any

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questions about the cases each specific case afterwards while

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it's loaded. And so with that we're

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gonna jump right in to a case. We're gonna start with

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a couple cases patients who presented with suspected

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my credit is after covid-19 vaccination. All

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of these are anonymized and I'll kind

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of give non-identifying data's you can understand the demographics

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before each one. So our first case

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I was a young male on young adult male

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at our Center. We don't scan pediatric patients. So

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all of the patients that will present today

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or 17 years of age or older. This is

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a young male patient to presented with cute onset

0:54

of chest pain and trapponian elevation.

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Thank you for cardiac MRI. We're gonna

1:00

start

1:00

Arsenius is that the images here on the left?

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I have our four chamber View and I'm going to play it for you and you

1:06

can see here. If you read cardigamri, you

1:09

can perhaps see that the left ventricle Global function

1:12

is impaired. So when we quantify that

1:15

let ventricular rejection fraction was 50% so mildly

1:18

impaired. There's no obvious valvular abnormality and

1:21

the right ventricle is near the lower limits

1:24

of normal diffraction as well.

1:26

I'm going to show you this short axis any SS.

1:30

FP clip and as we go through you want to look for regional law motion

1:33

abnormalities.

1:35

As well as the can assessment of function. And of course, this is

1:38

a stack that we Quantified on our

1:41

post personal things software and I'm just

1:44

going to go back to the base and draw your attention to the basal to

1:47

knit in for a lateral wall and perhaps you can see here

1:50

start to see here that that area of myocardium is thickened and

1:53

it's actually hypokinetic. So not only is

1:56

there a global well impairment of

1:59

function, but we also have a regionality and

2:02

so one of the key strengths of MRIs, of course the

2:05

ability to shoot that organizations and start with our

2:08

T2 weighted Imaging here's a black lot of

2:11

teaching way to sequence and this allows us to look for edema

2:14

in The myocardium

2:16

And I'm going to pull up a teach you mapping

2:19

image and we're gonna go back and I'm going to

2:22

show you how there is an abnormality that

2:25

becomes much more conspicuous when we window and

2:28

we can see here that myocardium remote

2:31

here at abnormality in the septum is

2:34

ISO intense just the little muscle but add

2:37

that basilism it in for a lot of wall. We have this area of

2:40

high signal intensity that we can see visually on our black blood

2:43

teach with image. This is telling us that there is increased water

2:47

and fluid in that area of cardium and

2:50

here on a corresponding teaching map. This

2:53

is a parametric mapping sequence. We can see visually that

2:56

there is higher values and again, very important to

2:59

look at your color lookup scale. I'm showing you here that

3:02

the scale is ranging from zero milliseconds dark

3:05

Navy all the way to 120 milliseconds

3:08

light yellow to White and so

3:11

areas that are more yellow

3:12

Or orange and yellow are higher on

3:15

T2 T2 mapping values and that's telling us again

3:18

that there is edema here.

3:21

One of the things that we're going to reiterate today and go over again in

3:24

the slides is there's two key MRI

3:27

features that we want to look for when we're thinking about acute marker.

3:30

That is one is a T2 based criteria.

3:33

Thinking about applying their revised Lake Louise criteria

3:36

and you can actually meet the teaching-based criteria in

3:39

more than one way. You only need to meet one of

3:42

the potential ways to meet a

3:45

teaching criteria. And so here we have both a regional hyperintensity

3:48

on teaching weighted Imaging and which

3:51

would qualify. We also have high teaching mapping

3:54

values. And so again, both of these are

3:57

telling us that there's a demon the next criteria that

4:00

we would want to look for is a T1 based abnormality traditionally.

4:03

I'm going to pull out an hour late going and has damage

4:06

our sequence rather. This is a short access to

4:09

stocks for kind of looking at a corresponding image here

4:12

on the left. This is a post-contract sequence

4:15

and really in the past. This is

4:18

kind of the work course tissue characterization not just

4:21

in my car that's another kind of map with these and this tells

4:24

us that there is an abnormal area of cardium that is

4:27

held on to or retained contrast.

4:29

And here this is at again at that

4:32

sub apocardial Angel wall. You can

4:35

also see that the pericardium is abnormal and enhancing overlying that

4:38

area of myocardium. So this is a patient

4:41

who had a mild pericarditis after vaccination and

4:44

now we have met not only our T2

4:47

based criteria, but also our T1 base criteria.

4:50

The other way that we can potentially meet the T1

4:53

base criteria that's required to make a diagnosis

4:56

of acute. My heart that is using the revise like Louise criteria is

4:59

with mapping here. I'm showing you a native

5:02

to and map so this is a non-contrast sequence. And of

5:05

course we can actually quantify these values. They were

5:08

elevated above our normal reference range, but I also think it's

5:11

important to look at the maps as well. Remember that. This is not just

5:14

a quantitative technique. It's an image just like

5:17

anything else and so visually we can see that again at

5:20

that in for a ladder wall. There is so that the Cardinal

5:23

high tea one values. These are above our reference range.

5:26

This would all so qualify as a tea

5:29

one-based on your melody in participation.

5:32

If we had Dan Post contrasting when mapping in addition to the need

5:35

of mapping we could calculate ecd that's not routine Center

5:38

for Clinical.

5:41

MRIs for macros patients, but certainly

5:44

that would be another potential way to meet that

5:47

t-1 base criteria. So to bring everything together in

5:50

this case reminder that this patient presented with

5:53

chest pain in an elevated drone level elevated troponin

5:56

level tells us that by definition. There's been myocyte

5:59

injury and bio sites of damaged reminder

6:02

troponin is a cardiac specific biomarker. And

6:05

then when we're looking at the MRI the key

6:08

parameters we want to assess for and saw in

6:11

this case our teaching-based criteria telling

6:14

us that there's a demon inflammation in The myocardium typically colocalizing

6:17

area of a

6:20

tea one based on our Melody either on lake and lemon has

6:23

Imaging or on our 21 mapping. In this

6:26

case. We also had Global and Regional life

6:29

particular dysfunction and a wall motion morality and

6:32

paracordin Hanson telling us that there is

6:35

a Mayo parent card that is

6:37

One of the key things that I think it's important to highlight

6:40

is that patients kind of

6:43

isolated paracetids for a number of reasons. It can be very extensive and

6:46

diffuse in the setting of a myocarditis. When

6:49

you have concominate paracorditis. It's often involving

6:52

the area of pericardium that's overline the

6:55

abnormal myocardium. So can be quite vocal and in

6:58

this case. So I think that's good to remind our apps and

7:01

tell our fellows, you know, you don't need to see the extent of pericardial enhancement

7:04

that sometimes you see in other causes of prayer card

7:07

that's going to be very vocal and

7:09

Option will be to an abnormal ECG with

7:12

ST segment and g-wave changes. And so

7:15

this kind of is a really

7:19

Imaging

7:20

the most common pattern virtual fee repeatedly throughout the

7:23

cases today is sub-apocardial involvement which

7:26

we see beautifully here on this LGE image.

7:29

And again the abnormalities on

7:32

T1 and T2 based Imaging typically

7:35

localized. We're seeing them in that same area

7:38

of myocardium.