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T2 Oedema Without LGE — EECC MCQ

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ModerateCardiac ImagingT2 Oedema Without LGEEECC

A 55-year-old man with chest pain and troponin elevation undergoes CMR after normal coronary angiography. The CMR shows oedema in the mid-anterior wall on T2 mapping but no LGE. NT-proBNP is mildly elevated. LVEF is 58%. What does the absence of LGE with T2 oedema suggest?

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Correct answer: B — Acute myocardial injury with inflammation but without necrosis or scar — this pattern can be seen in mild/early myocarditis, Takotsubo, or very early MI before scar forms; it generally indicates a favourable prognosis with expected recovery

CMR tissue characterisation enables differentiation of myocardial injury patterns: (1) T2 oedema + LGE = acute injury with necrosis/scar (myocarditis, acute MI); (2) T2 oedema WITHOUT LGE = acute injury without significant necrosis — a milder phenotype seen in: (a) mild/early myocarditis (inflammation without extensive myocyte death — Lake Louise criteria still met if T1 criteria positive); (b) Takotsubo (oedema without significant scar — characteristic); (c) very early acute MI (oedema precedes scar formation by hours-days). Absence of LGE generally predicts favourable prognosis with expected recovery of function. Follow-up CMR at 3-6 months confirms resolution. The 2025 ESC Myocarditis/Pericarditis Guidelines use parametric mapping (T1, T2, ECV) alongside LGE for comprehensive tissue characterisation.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines; SCMR Mapping Consensus