Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis

Abstract

A combined CMR approach using T2-weighted imaging, early and late gadolinium enhancement, provides a high diagnostic accuracy and is a useful tool in the diagnosis and assessment of patients with suspected acute myocarditis.

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

“…When predominating in the subepicardial layers of myocardium, DCE was recently found to constitute a highly specific sign of myocarditis (100%) (21) and to correspond to active sites of myocarditis on endomyocardial biopsy (20). The subepicardial DCE were commonly displayed into patchy areas and always involved the lateral wall, as already described for the active foci of myocarditis (10 -14, 20).…”

“…The "cougar like pattern" of necrotic islands in myocarditis, with scars shrinking and remodeling during healing, as well as the subsequent resolution of edema, are likely to explain the important regression of DCE areas in these patients (22). The evolution of the inflammatory pro- cess, from a focal to a disseminated involvement of the myocardium, might also progressively lower the visual detection of DCE areas (21).…”

“…10-year cardiovascular risk; 3) higher incidence of strictly normal coronary angiogram; 4) higher LV enddiastolic volume, a common finding in acute myocarditis (36); and 5) unusual association with SPECT-perfusion defects at rest (17% of patients), whereas such defects are commonly documented in ischemic necrosis but not in active myocarditis (37)(38)(39). Reported incidence of DCE in myocarditis ranges from 44% to 88%, possibly reflecting virus related differences in the pattern of myocardial injury, as well as differences in the delay between disease onset and the time of MRI (20,21). In the present study, all patients with myocarditis DCE pattern had a recent episode of chest pain and enzyme leakage and, therefore, all were likely to be in the early phase of the disease, when sensitivity of DCE analysis is expected to be the highest (21).…”

“…Reported incidence of DCE in myocarditis ranges from 44% to 88%, possibly reflecting virus related differences in the pattern of myocardial injury, as well as differences in the delay between disease onset and the time of MRI (20,21). In the present study, all patients with myocarditis DCE pattern had a recent episode of chest pain and enzyme leakage and, therefore, all were likely to be in the early phase of the disease, when sensitivity of DCE analysis is expected to be the highest (21). In addition, at the difference of previous studies, a paired display of the cine SSFP movies acquired before and after the tracer injection was added to the analysis of IR-GRE static images.…”

“…DCE identifies acute or chronic myocardial infarction even when restricted to small subendocardial areas (17,18). MRI with hyperenhancement gadolinium-tracer analysis has also been successfully applied in identifying myocarditis, either by using a nonbreathhold T1-weighted spin-echo pulse sequence (19), or the newer inversion-recovery gradient-echo pulse (IR-GRE) sequences dedicated to DCE analysis (20,21). In this setting, the DCE areas are commonly documented in the subepicardial layers of the left ventricle, close to the pericardium, especially on the lateral wall (20).…”