Incremental value of quantitative CMR including parametric mapping for the diagnosis of acute myocarditis

Abstract

NCT02299856.

Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance

“…18 In the meantime, T1 mapping has been introduced and histologically validated to detect diffuse myocardial damage. 12 Several studies have already reported the additive value of elevated native T1 relaxation times in subjects with acute myocarditis, achieving a diagnostic accuracy of 61% to 99%, 13,15,16,27 and the present study came to a result in between this range (78%). The cutoff, which discriminated best acute myocarditis subjects from healthy controls, was 980 ms, which is in the range of the 990 ms reported by Ferreira et al, 13 992 ms by Hinojar et al, 15 and 1000 ms by Luetkens et al 16 At acute presentation, the elevated native T1 less probably represents fibrosis, but edema, hyperemia, and myocardial necrosis.…”

“…Moreover, the general level of ECV was lower in this study as compared with that in other studies. Although in the present study an ECV of 0.24 achieved the best results, this cutoff was 0.29 in the studies by Luetkens et al 16 and by Radunski et al 27 This discrepancy may be explained by differences in the T1 techniques, timing of the postcontrast T1 maps, as well in the patient samples. For example, the population of the present study was younger as the one by Radunski et al 27 and had a higher ejection fraction (60% vs. 42%).…”

“…13,15 T2 times have been proposed as a good parameter to assess the activity of myocarditis. 10 To date, clinical investigators have mostly focused on assessing either acute or chronic myocarditis, 15,16 whereas preclinical studies have already covered both aspects. 17 The exact temporal evolution of the range of myocarditis-related injuries over the course of myocarditis in the same group of patients has only been reported for the LLC some years ago, 18 and recently for T1 mapping by Hinojar et al 15 In the present study, both T1 and T2 maps have been acquired repeatedly in subjects with clinically diagnosed myocarditis in the acute phase, in a short-term follow-up, and during reconvalescence.…”

“…Previous publications reported lower values of 70% or 76%. 6,16 The higher than expected success rate of the T2 ratio can be related to several factors. First, all CMR exams were done in a center with large experience with T2-weighted imaging, and the translation of this technical success rate to less experienced centers is questionable.…”

Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study

“…Using T1 values before and after administration of an extracellular contrast agent, allows the additional calculation of the extracellular volume (ECV), well-established in cardiac MRI 8. As liver fibrosis is defined by an increase of extracellular matrix,1 ECV is a physiologically intuitive unit of measurement, independent of field strength and thus suitable for follow-up examinations using different scan sites.…”