Diagnostic power of cardiac imaging techniques at different levels of pathophysiology. CMR = cardiac magnetic resonance; CT = computed tomography; Echo = echocardiography; Nuclear = nuclear cardiology techniques.

(Upper panels) Diastolic (left) and systolic (right) frames in a short-axis view. (Lower panels) T₂-weighted (left) and post-contrast T₁-weighted (late enhancement) (right) images showing infarction-related transmural edema but only subendocardial necrosis (see Online Video 1).

(Upper panels) Diastolic (left) and systolic (right) frames in a short axis view with akinesis of the inferoseptal and inferior segments. (Lower panels) T₂-weighted (left) and post-contrast T₁-weighted (late enhancement) (right) images showing no edema, but transmural fibrosis (arrows) within the akinetic region (see Online Video 2).

(Upper panels) Diastolic (left) and systolic (right) frames of a cine study showing pericardial effusion (bright signal) and largely preserved systolic function. (Lower panels) T₂-weighted (left) and post-contrast T₁-weighted (late enhancement) (right) images showing lateral edema (arrows) and focal fibrosis typical for the nonischemic injury pattern of myocarditis (arrows) (see Online Video 3).

(Upper panels) Diastolic (left) and systolic (right) frames in a short-axis view. (Lower panels) T₂-weighted (left) and post-contrast T₁-weighted (late enhancement) (right) images showing infarct-related transmural edema with transmural necrosis of the same size (see Online Video 4).

(Upper panels) Diastolic (left) and systolic (right) frames in a short-axis view showing preserved wall thickness of the lateral wall but regional akinesis of the anterolateral and inferolateral segments. (Lower panels) T₂-weighted (left) and post-contrast T₁-weighted (late enhancement) (right) images showing infarction-related transmural edema and matching necrosis in the dysfunctional segments. Both, T₂-weighted and late enhancement images show a core with reduced signal intensity reflecting no-reflow (arrowheads) (see Online Video 5).

(Left panel) Diastolic (upper) and systolic (lower) frames of a cine study showing hyperdynamic systolic function. (Middle panel) Non-breath-hold T₁-weighted images acquired before (upper) and over the first minutes after gadolinium indicating significant myocardial gadolinium uptake. The uptake ratio (early enhancement) was increased. (Right upper panel) T₂-weighted image with high signal intensity of the anterior wall. (Right lower panel) Post-contrast T₁-weighted (late enhancement) image showing possible diffuse necrosis but lack of regional injury (see Online Video 6).

(Left panel) Diastolic (upper) and systolic (lower) frames of a cine study showing grossly systolic function with mild septal hypokinesis. (Middle panel) Non-breath-hold T₁-weighted images acquired before (upper) and over the first minutes after gadolinium indicating significant myocardial gadolinium uptake. The uptake ratio (early enhancement) was increased. (Right upper panel) T₂-weighted image with high signal intensity of the septum (arrow). (Right lower panel) Post-contrast T₁-weighted (late enhancement) image showing a focal scar in the lateral wall but no necrosis in the septal region (see Online Video 7).

This CMR image of a patient with remote myocarditis shows chronic multifocal, partially subendocardial scarring in a T₁-weighted (late enhancement) image.

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(A) The CMR images taken at admission of an elderly woman who presented with acute anterior infarction and invasive exclusion of relevant coronary artery stenosis. (Left panel) Diastolic (upper) and systolic (lower) frames of a breath-hold cine study, showing typical extensive mid-ventricular and apical dyskinesia ("ballooning"). (Right upper panel) T₂-weighted image showing diffuse intraventricular high signal intensity due to slow flowing blood as well as an increased signal intensity of the mid-ventricular and apical myocardium, presumably reflecting myocardial edema. (Right lower panel) Late gadolinium enhancement study showing no subendocardial high signal intensity but some diffuse late enhancement of the dysfunctional segments. The final diagnosis in this patient was acute stress-induced cardiomyopathy (see Online Video 8). (B) Follow-up study of the same patient after 4 weeks. (Left panel) Diastolic (upper) and systolic (lower) frames of a breath-hold cine study, showing normalization of systolic function. (Right upper panel) T₂-weighted image showing homogeneous signal intensity. (Right lower panel) Late gadolinium enhancement study showing persisting diffuse late enhancement of the dysfunctional segments (see Online Video 9).