Diagnostic Performance of CMR Imaging Compared With EMB in Patients With Suspected Myocarditis

Abstract

The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management.

Significance of different non-invasive markers in diagnosis of latent myocarditis in comparison with biopsy data

“…Like this according to Sharite clinic data, sensitivity of delayed accumulation of contrast agent in myocardium is only 30.6% while specificity is 88.1% [14]. These values were 39.3% and 93.1% in case of combination of signs (delayed accumulation and «ede-ma» in T1-and T2-regimes) while other authors report insufficiently high specificity of MRI (54%) [12]. Besides, the method is more informative in case of acute myocarditis.…”

“…Авторами рекомендаций приводится пе-речень современных клинико-лабораторно-инструмен-тальных методов, которые следует использовать для вы-явления возможного миокардита, однако сопоставление с морфологическим исследованием проведено лишь для некоторых из них (в частности, МРТ) и дало противоре-чивые результаты. Так, по данным клиники Шарите, чув-ствительность отсроченного накопления контрастного препарата в миокарде составляет всего 30,6% при специ-фичности 88,1% [14], для комбинации признаков (отсро-ченное накопление и «отек» в режимах Т1 и Т2) эти пока-затели составляют 39,3 и 93,1%, в то время как другие ав-торы сообщают о недостаточно высокой специфичности МРТ (54%) [12]. Кроме того, метод информативнее при остром миокардите.…”

Modern Imaging of Myocarditis: Possibilities and Challenges

“…The largest to date meta-analysis dealing with the T2-ratio showed an average sensitivity of 70 % and an average specificity of 71 % for detecting myocardial edema [21]. The threshold of ≥ 1.9, however, has been established using a body coil in combination with a T2w black blood sequence [22] and only limited validation studies of this threshold have been performed with respect to different coils, scanners, field strengths and sequence types [24]. In addition, systemic inflammatory conditions in which skeletal muscles may equally be involved limit the sensitivity of diagnostic ap- proaches in which SI is normalized to the skeletal muscle and can lead to false-negative results.…”

“…In addition, systemic inflammatory conditions in which skeletal muscles may equally be involved limit the sensitivity of diagnostic ap- proaches in which SI is normalized to the skeletal muscle and can lead to false-negative results. This and several technical limitations of T2w imaging in the heart have relativized the diagnostic usefulness of the first criterion over the last few years [24] and novel methods (e. g. T1 and T2 mapping) are currently being evaluated as potential alternative approaches to overcome these limitations, as further discussed below. Similar problems arise for the second diagnostic criterion, the EGEr.…”

“…An EGEr ≥ 4 is regarded as pathological [22]. This threshold was also established using a body coil and until now, only limited validation studies of the threshold with respect to different coils, field strengths and scanner types are known [24]. As in the case of the T2-ratio, systemic inflammatory conditions might lead to false-negative results when normalizing the pre-and post-gadolinium SI to skeletal muscles.…”