<International Circulation>: The diagnosis and treatment of myocarditis is your area of expertise. What advances have been seen in the diagnosis of myocarditis especially with respect to imaging and endomyocardial biopsy?

    Dr Liu: The challenge with myocarditis is that it is under-diagnosed clinically because traditionally we have not had good diagnostic tools， except for cardiac biopsy and looking for evidence of virus， and this is not always commonly available. Also the use of molecular technology is fairly restricted in its use. In the last decade， but particularly within the last year， the development and consensus of use of non-invasive techniques using magnetic resonance imaging has been quite exciting. When the heart is undergoing inflammation/myocarditis， there is the presence of edema and also changes in structure of the heart. Magnetic resonance imaging is very good in terms of picking up tissue characteristics. So firstly there can be seen an increase in T2 on the images and additionally， if the patient is given gadolinium， the enhancement can be seen in the myocardium. So using a combined criteria of T2 increase and enhancement， particularly late enhancement with gadolinium， the sensitivity is around 90% and the specificity around 95%， which is very impressive. This technique can then be used in a broader range of patients who you suspect of myocarditis and one can make a fairly accurate early diagnosis to initiate treatment. It would only be those patients who are further hemodynamically compromised or non-responders to treatment for whom you would consider biopsy to get a better diagnosis.