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Myocardial edema—a new clinical entity?

Nature Reviews Cardiology volume 7, pages 292–296 (2010)Cite this article

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Abstract

Edema is a generic component of the tissue response to acute injury and, therefore, an important diagnostic target for assessing the acuity of tissue damage in vivo. In the past, edema could not be used as a diagnostic target, because even histological techniques failed to provide reliable qualitative or even quantitative data on its presence, extent, and regional distribution. Cardiac MRI is about to change that. Using water-sensitive MRI, visualization of myocardial edema in vivo is possible within a few breath holds, without using radiation or contrast agents. Edema imaging provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with suspected acute myocardial injury. In combination with scar imaging, MRI differentiates reversible from irreversible injury and can quantify myocardial salvage after coronary revascularization. With this unique contribution, MRI of edema should be considered an essential diagnostic tool and, as part of a multitarget MRI scan, illustrates the exceptional role of comprehensive cardiac MRI in diagnosing and staging myocardial diseases safely and efficiently.

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Figure 1: A simplified schematic view of edema evolution in ischemic injury to the myocardium.
Figure 2: Change in T2 relaxation after experimental coronary occlusion.
Figure 3: Myocardial edema in a patient 2 days after acute, reperfused myocardial infarction (mid-ventricular, short-axis views).
Figure 4: Regional myocardial edema in a patient with active myocarditis.
Figure 5: Diffuse myocardial edema in a patient with active myocarditis.
Figure 6: Myocardial edema of myocardial salvage after acute, reperfused myocardial infarction (midventricular short-axis views).

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Acknowledgements

I want to cordially thank John V. Tyberg, James Hare, and Jordin D. Green for their helpful review of the manuscript, Marc Henry for his valuable thoughts, and Ingo Eitel for providing the images for Figure 6.

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  1. Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, University of Calgary, 1403 29th Street NW, Calgary, T2N 2T9, AB, Canada

    Matthias G. Friedrich

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Friedrich, M. Myocardial edema—a new clinical entity?. Nat Rev Cardiol 7, 292–296 (2010). https://doi.org/10.1038/nrcardio.2010.28

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