Fig. 4

Multi-parametric tissue characterisation at mid-slice in acute chest pain syndromes. On ECV-maps, red areas represent ECV greater than 30%. T1-mapping was done using a modified Look-Locker Inversion Recovery (MOLLI) pulse sequence on 1.5 Tesla Ingenia, Philips, Best, The Netherlands. a Acute myocarditis with higher native T1-values in the infero-lateral wall of the left ventricle (a1) consistent with LGE in the mid inferior-lateral wall (a2, yellow arrow). The ECV map (a3) demonstrates diffusely increased extra-cellular space. b Takotsubo Cardiomyopathy (TC) with diffusely high native T1 values (b1), no evidence of focal LGE (b2) and diffusely increased ECV (b3). c Acute re-perfused ST-elevation myocardial infarction affecting the inferior wall. Native T1-vales are raised in the area of risk (>1000ms) and also in the remote myocardium. On LGE imaging, inferior infarction with an area of microvascular obstruction can be seen (yellow arrow, c2). ECV is raised in the infarct zone but low in the MVO as this area does not take up any contract (yellow arrow, c3). d Anterior wall ST-elevation myocardial infarction with rupture of the left ventricle free wall (not seen in these images) resulting in haemo-pericardium. The pericardial haemorrhage has high native T1 values (black arrow, d1), high signal on LGE and low ECV values (d3). e Chronic MI in the antero-septal wall. There is an area of reduced native T1 values in the septum (green arrow, e1) which corresponds to lipomatous metaplasia transformation in previous antero-septal infarct. There is also an acute infarction in the lateral wall with some peri-infarct oedema seen on native T1. Abbreviations: AMI, acute myocardial infarction; ECV, extra-cellular volume; MI, myocardial infarction; LGE, Late Gadolinium Enhancement; TC, Takotsubo Cardiomyopathy