Usefulness of Late Iodine Enhancement on Spectral CT in Acute Myocarditis

Bouleti, Claire; Baudry, Guillaume; Iung, Bernard; Arangalage, Dimitri; Abtan, Jérémie; Ducrocq, Grégory; Steg, Philippe Gabriel; Vahanian, Alec; Henry–Feugeas, Marie-Cécile; Pasi, Nicoletta; Chillon, Sylvie; Pitocco, Francesca; Laissy, Jean-Pierre; Ou, Phalla

doi:10.1016/j.jcmg.2016.09.013

Cited by 37 publications

(30 citation statements)

References 3 publications

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“…Currently, only little data is available on the performance of LIE CT in patients with acute myocarditis. 109,112 Of note, the largest analysis including 20 patients with CMR-proven acute myocarditis was performed with spectral CT. 113 In this proof-of-concept study, LIE spectral CT showed a sensitivity of 100% in the detection of myocardial fibrosis on a per-patient based-analysis compared to LGE CMR. Additional evaluation of pre-contrast and post-contrast CT images allows myocardial ECV assessment.…”

Section: Role Of Ct In the Diagnosis Of Acute Myocarditis In Covid-19mentioning

confidence: 76%

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

118

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Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.

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Section: Role Of Ct In the Diagnosis Of Acute Myocarditis In Covid-19mentioning

confidence: 76%

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

118

View full text Add to dashboard Cite

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“…In this recent study, the cut-off suggested was of 39.5% which is highlighting a higher myocarditis inflammation burden that is consequently at risk. Finally, the present study is bringing one more contribution to the DECT for being a quick appropriate alternative candidate to CMR in cardiac emergency facilities [ 23 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Restier

Boccalini

Congi

et al. 2021

JCM

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Background: Myocardial extracellular volume (ECV) is a marker of the myocarditis inflammation burden and can be used for acute myocarditis diagnosis. Dual-energy computed tomography (DECT) enables its quantification with high concordance with cardiac magnetic resonance (CMR). Purpose: To investigate the diagnostic performance of myocardial ECV quantified on a cardiac dual-layer DECT in a population of patients with suspected myocarditis, in comparison to CMR. Methods: 78 patients were included in this retrospective monocenter study, 60 were diagnosed with acute myocarditis and 18 patients were considered as a control population, based on the 2009 Lake and Louise criteria. All subjects underwent a cardiac DECT in acute phase consisted in an arterial phase followed by a late iodine enhancement phase at 10 min after injection (1.2 mL/kg, iodinated contrast agent). ECV was calculated using the hematocrit level measured the day of DECT examinations. Non-parametric analyses have been used to test the differences between groups and the correlations between the variables. A ROC curve has been used to identify the optimal ECV cut-off discriminating value allowing the detection of acute myocarditis cases. A p value < 0.05 has been considered as significant. Results: The mean ECV was significantly higher (p < 0.001) for the myocarditis group compared to the control (34.18 ± 0.43 vs. 30.04 ± 0.53%). A cut-off value of ECV = 31.60% (ROC AUC = 0.835, p < 0.001) allows to discriminate the myocarditis with a sensitivity of 80% and a specificity of 78% (positive predictive value = 92.3%, negative predictive value = 53.8% and accuracy = 79.5%). Conclusion: Myocardial ECV enabled by DECT allows to diagnose the acute myocarditis with a cut-off at 31.60% for a sensitivity of 80% and specificity of 78%.

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“…Recently, late iodine enhancement (LIE) imaging has been an emerging and promising diagnostic alternative to LGE-CMR, allowing the measurement of myocardial extracellular volume ( 10 ). In a single-center retrospective study of 20 patients with CMR-proven acute myocarditis, spectral CT with LIE was extremely useful for diagnosing acute myocarditis (82% sensitivity, 99% specificity, 94% positive predictive value, 95% negative predictive value, and 95% overall accuracy) ( 11 ). Further accumulation and analysis of data are required on the evaluation of myocarditis using CT.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Acute Eosinophilic Myocarditis With a Low-Flow Heart Failure With Preserved Ejection Fraction Phenotype

Aota

Yamamoto

Isogai

et al. 2021

Front. Cardiovasc. Med.

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Eosinophilic myocarditis is a rare subtype of myocarditis characterized by myocardial eosinophilic infiltration, and it is potentially fatal if left untreated. Although endomyocardial biopsy (EMB) is a cornerstone for the histological diagnosis of acute eosinophilic myocarditis (AEM), as it is an invasive procedure and has a low diagnostic accuracy, the diagnosis of AEM with hemodynamic instability remains challenging. We describe a case of AEM presenting as low-flow heart failure with preserved ejection fraction (HFpEF), with rapid progression to cardiogenic shock. The constellation of peripheral eosinophilia, increased left ventricular wall thickness, and HFpEF raised the suspicion of AEM. Contrast-enhanced computed tomography (CT) scan revealed heterogeneous hypoenhancement localized in the basal-to-mid septal and mid anterolateral walls of the left ventricle, strongly suggestive of acute inflammation. Based upon these findings, we performed CT-guided EMB, which lead to a definitive diagnosis. Subsequent high-dose corticosteroids allowed a rapid and dramatic recovery and normalization of cardiac structure and function. This case highlights the clinical importance of assessing AEM as a rare cause of HFpEF and the usefulness of CT-guided EMB in patients with hemodynamic instability.

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Usefulness of Late Iodine Enhancement on Spectral CT in Acute Myocarditis

Cited by 37 publications

References 3 publications

Role of computed tomography in COVID-19

Role of computed tomography in COVID-19

Diagnostic Performance of Extracellular Volume Quantified by Dual-Layer Dual-Energy CT for Detection of Acute Myocarditis

Case Report: Acute Eosinophilic Myocarditis With a Low-Flow Heart Failure With Preserved Ejection Fraction Phenotype

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