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type:Case Report, The pathophysiology of myocarditis is associated with mild inflammation and may progress silently, or in severe cases such as fulminant myocarditis, may lead to sudden hemodynamic compromise. An invasive myocardial biopsy is generally required for a definitive myocarditis diagnosis. Alternatively, cardiac magnetic resonance (CMR), which evaluates myocardial characteristics and cardiac function, can be used as a noninvasive tool for diagnosing myocarditis. We describe the cases of a 49-year-old woman with mild acute eosinophilic myocarditis and a 48-year-old man with severe acute lymphocytic myocarditis. CMR was performed during the acute and convalescent phases in both cases. Compared with mild myocarditis, CMR in severe myocarditis showed higher T2 values and decreased left ventricular and atrial volumes and strains; however, the right ventricular strain was preserved. Late gadolinium enhancement showed faint contrast enhancement in the whole and strong enhancement in the local myocardium. Follow-up CMR showed recovery from myocardial inflammation and cardiac function. Some late gadolinium enhancement persisted whereas acute inflammation-associated enhancement disappeared. This case report highlights the differences between the cardiac parameters of patients with mild and severe myocarditis. Severe myocardial inflammation can be caused by severe heart failure owing to the concurrent reduction of cardiac function and compliance. Additionally, preserved right ventricular strain may predict cardiac function recovery in acute myocarditis. Noninvasive and repeatable CMR provides information on myocardial characteristics, cardiac function, and hemodynamics in a single scan at that time, which is useful not only for diagnosis but also for severity assessment and patient management in acute myocarditis.

type:Aricle, Cardiac cine magnetic resonance imaging (MRI) is a widely used technique for the noninvasive assessment of cardiac functions. Deep neural networks have achieved considerable progress in overcoming various challenges in cine MRI analysis. However, deep learning models cannot be used for classification because limited cine MRI data are available. To overcome this problem, features from cine image settings are derived by handcrafting and addition of other clinical features to the classical machine learning approach for ensuring the model fits the MRI device settings and image parameters required in the analysis. In this study, a novel method was proposed for classifying heart disease (cardiomyopathy patient groups) using only segmented output maps. In the encoder–decoder network, the fully convolutional EfficientNetB5-UNet was modified to perform the semantic segmentation of the MRI image slice. A two-dimensional thickness algorithm was used to combine the segmentation outputs for the 2D representation of images of the end-diastole (ED) and end-systole (ES) cardiac volumes. The thickness images were subsequently used for classification by using a few-shot model with an adaptive subspace classifier. Model performance was verified by applying the model to the 2017MICCAIMedical Image Computing and Computer-Assisted Intervention dataset. High segmentation performance was achieved as follows: the average Dice coefficients of segmentation were 96.24% (ED) and 89.92% (ES) for the left ventricle (LV); the values for the right ventricle (RV) were 92.90% (ED) and 86.92% (ES). The values for myocardium were 88.90% (ED) and 90.48% (ES). An accuracy score of 92% was achieved in the classification of various cardiomyopathy groups without clinical features. A novel rapid analysis approach was proposed for heart disease diagnosis, especially for cardiomyopathy conditions using cine MRI based on segmented output maps.

type:Original Article, Objective: We proposed the use of standard two-dimensional (2D) cine MR images with inter-slice interpolation to evaluate three-dimensional (3D) left ventricular (LV) global area strain (GAS), and investigated its clinical applicability by comparing to 2D strains. / Materials and Methods: Twenty-one consecutive patients with ischemic cardiomyopathy (ICM) (63±12 years) and 12 controls without cardiac disease (68±13 years) were retrospectively enrolled. Receiver operating characteristic analysis was performed to determine the optimal cutoff of circumferential strain (CS), radial strain (RS), longitudinal strain (LS), and GAS for detection of patients with LV ejection fraction (LVEF) ≤45%. Comparison of CS, RS, LS, and GAS between controls and ICM patients was analyzed by the Wilcoxon rank-sum test. / Results: The optimal cutoff of GAS has the highest diagnostic performance for detection of patients with LVEF ≤45% [area under the curve (AUC), 0.97; sensitivity, 88%; specificity, 100%] compared to the other 2D strains (CS vs. RS vs. LS; AUC, 0.85 vs. 0.85 vs. 0.73; sensitivity, 75% vs. 100% vs. 50%; specificity, 85% vs. 77% vs. 85%). LS and GAS were significantly greater for controls than ICM patients (LS: -18.6±3.2% vs. -10.1±3.2%, p<0.01, GAS: -41.3± 5.3% vs. -26.0±8.2%, p<0.01). / Conclusion: GAS derived from inter-slice interpolation of 2D cine MRI is a quantitative index of 3D myocardial motion, and this technique can be applied for clinical MR examinations.

Nondrug therapy for arrhythmia patients had been developed dramatically until recent years. Cardiac resynchronization therapy (CRT), a nondrug therapy for arrhythmia, is especially utilized for the treatment of left ventricular (LV) severe heart failure caused by cardiac dyssynchrony. Prolonged QRS duration (≧130 ms) is strongly used as a CRT indication criterion, but QRS is not the direct clinical index of mechanical contraction delay of the LV myocardium. Therefore, identifying the presence of dyssynchrony by diagnostic imaging is necessary. Echocardiography is widely used for the assessment of dyssynchrony as a standard diagnostic imaging. Several studies have addressed the efficacy of cardiovascular magnetic resonance feature tracking (CMR-FT) in the diagnosis of dyssynchrony for arrythmia patients. In addition, cardiac implantable electronic devices (CIEDs) were not available to examine CMR until recent years; however, new MR-conditional CIEDs have become available for use before and after CRT. Recently, diagnostic imaging using CMR-FT has been attracting attention for the assessment of dyssynchrony. However, a strong metal artifact caused by CIEDs may make the analysis difficult after CRT implantation. Strain analysis using short-axis (SA) cine CMR overcame this issue of artifact by enabling slice selection by avoiding artifact. Moreover, circumferential strain has superiority over other strain methods with respect to sensitivity, and we focused on these advantages. This case illustrates that circumferential strain with CMR-FT using SA cine CMR is useful in the assessment of improvement of myocardial motion after CRT and can provide useful additional information with imaging to determine the responders of CRT.