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 304 (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 4weeks and remained within the normal range in most patients after 30months. Contrast enhancement 4weeks after onset of symptoms was predictive for the functional and clinical long-term outcome. Contrast-enhanced MRI may be a useful, noninvasive tool for long-term follow-up of patients with acute myocarditis. Furthermore, relatively early MRI findings may predict longer-term outcomes.