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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Appearance of myocarditis lesions on spectral CT arterial acquisitions and correlation with edema on MRI

Sara Boccalini1,2, Clara Fourrier3, Salim Si-Mohamed3,4

  • 1Department of Cardiovascular and Thoracic Radiology, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France. sara.boccalini@yahoo.com.

European Radiology Experimental
|September 11, 2025
PubMed

Insights

Spectral CT can detect myocarditis lesions on arterial and late-enhancement (LE) scans. Hypodense lesions on the arterial phase, indicative of edema, are more pronounced in patients with MRI-confirmed edema.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Medical Diagnostics

Background:

  • Spectral computed tomography (CT) late-enhancement (LE) is used for myocarditis detection.
  • The appearance of myocarditis on arterial phase spectral CT is not well understood.
  • This study investigates myocarditis visualization on arterial phase spectral CT and its relation to LE and edema.

Purpose of the Study:

  • To assess the appearance of myocarditis on arterial acquisitions of cardiac spectral CT.
  • To correlate arterial phase findings with late-enhancement (LE) and myocardial edema.
  • To understand the diagnostic utility of arterial phase spectral CT for myocarditis.

Main Methods:

  • Retrospective analysis of 47 cardiac spectral CTs in patients with MRI-confirmed myocarditis.
  • Identification and segmentation of three myocardial attenuation/enhancement patterns (HypoArt-NorLE, NorArt-HyperLE, HypoArt-HyperLE).
  • Comparison of spectral and conventional image characteristics and correlation with MRI T2 mapping for edema assessment.

Main Results:

  • 173 myocarditis lesions were identified across the three patterns.
  • HypoArt-HyperLE lesions showed significant hypodensity and lower iodine content on the arterial phase compared to remote myocardium.
  • Hypodense arterial phase lesions correlated with the presence of edema on MRI, indicating a relationship between arterial phase findings and myocardial edema.

Conclusions:

  • Most myocarditis lesions are detectable on both arterial and LE spectral CT acquisitions.
  • Arterial phase spectral CT can depict myocarditis lesions as epicardial hypodense areas, often associated with edema.
  • The arterial phase appearance of myocarditis lesions, particularly hypodensity, is more pronounced in the presence of myocardial edema.
Abstract

Keywords:
Coronary vesselsEdema (cardiac)Magnetic resonance imagingMyocarditisTomography (X-ray computed)

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