{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T18:52:37Z","timestamp":1787424757410,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Cardiac magnetic resonance (cMRI) is often used to diagnose acute myocarditis (AM). It is also performed after 6 months to monitor myocardial involvement. However, the clinical and predictive relevance of the 6-month cMRI is uncertain. Objective: We used cMRI to assess the morphology and heart function of patients with AM, the correlation between left ventricular remodeling and biomarkers of heart dysfunction and myocardial fibrosis, and the involvement of myocardial fibrosis initially and 6 months after the acute episode. Materials and methods: We conducted a prospective study of 90 patients with the clinical suspicion of AM, where cMRI was performed within the first week after symptom onset and repeated after 6 months. Results: Non-ischemic late gadolinium enhancement (LGE) was present in 88 (97.7%) patients and mainly involved the septum and inferior wall. cMRI at 6 months was associated with significantly reduced abnormalities of segmental kinetics (p &lt; 0.001), myocardial edema (p &lt; 0.001), presence of LGE (p &lt; 0.05) and LGE mass (p &lt; 0.01), native T1 mapping (p &lt; 0.001), and presence of pericardial collection (p \u2264 0.001). At 6 months, signs of myocardial edema appeared in 34.4% of patients, and a complete cure (absence of edema and LGE) was found in 8.8% of patients. LGE disappeared in 15.2% of patients, and the mean number of myocardial segments involved decreased from 46% to 30%, remaining unchanged in 13% of patients. Patients with LGE without edema had a more severe prognostic condition than those with persistent edema. Patients with increased LGE extension on the control cMRI had a worse prognosis than those with modified or low LGE. The most significant independent predictive parameters for major cardiovascular events (MACEs) were LGE mass (adjusted OR = 1.27 [1.11\u20131.99], p &lt; 0.001), myocardial edema (OR = 1.70 [1.14\u2013209.3], p &lt; 0.001), and prolonged native T1 (OR = 0.97 [0.88\u20133.06], p &lt; 0.001). The mid-wall model of LGE and the presence of edema-free LGE were MACE-independent predictors. Conclusions: LGE, myocardial edema, and prolonged native T1 were predictors of MACEs. LGE does not necessarily mean constituted fibrosis in the presence of edema and may disappear over time. LGE without edema could represent fibrosis, whereas the persistence of edema represents active inflammation and could be associated with the residual chance of complete recovery. cMRI should be performed in all patients with AM at 6 months to evaluate progress and prognosis.<\/jats:p>","DOI":"10.3390\/diagnostics14131426","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T11:35:57Z","timestamp":1720006557000},"page":"1426","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Role of Magnetic Resonance Imaging in Risk Stratification of Patients with Acute Myocarditis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4861-551X","authenticated-orcid":false,"given":"Alexandra","family":"Popa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Cionca","sequence":"additional","affiliation":[{"name":"Department of Radiology, Affidea Hiperdia Diagnostic Imaging Centre, 400487 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Agoston","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flaviu","family":"Rusu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Mihai","family":"Tarcau","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Science, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9783-8317","authenticated-orcid":false,"given":"Andra","family":"Negru","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8638-496X","authenticated-orcid":false,"given":"Rares Ilie","family":"Orzan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Regional Institute of Gastroenterology and Hepatology \u201cProf. Dr. Octavian Fodor\u201d, 400162 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Agoston-Coldea","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Department of Radiology, Affidea Hiperdia Diagnostic Imaging Centre, 400487 Cluj-Napoca, Romania"},{"name":"Department of Internal Medicine, Emergency County Hospital, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1253\/circj.CJ-16-0234","article-title":"Clinical features of acute and fulminant myocarditis in children\u20142nd nationwide survey by Japanese Society of pediatric cardiology and cardiac surgery","volume":"80","author":"Matsuura","year":"2016","journal-title":"Circ. 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