Magnetic resonance imaging (MRI) reveals cardiac signal intensity changes in patients with acute myocarditis; however, the natural history of these changes and their relationship to individual outcomes are unknown. The relationship of MRI findings to long-term outcome was studied by serial MRI studies in 16 patients with acute myocarditis who were followed for 30+/-4 (SE) months. Myocardial contrast enhancement was monitored using contrast-enhanced T1-weighted fast spin-echo images. Left ventricular ejection fraction was measured with gradient-echo sequences. Clinical symptoms were scored. The results were compared to a control group of 26 age-matched, healthy volunteers. Myocardial contrast enhancement, which was markedly increased in the early course of the disease, decreased at 4 weeks and remained within the normal range in most patients after 30 months. Contrast enhancement 4 weeks after onset of symptoms was predictive for the functional and clinical long-term outcome.Contrast-enhanced MRI may be a useful, noninvasive tool for longterm follow-up of patients with acute myocarditis. Furthermore, relatively early MRI findings may predict longer-term outcomes.