Clinical Research
Cardiac Imaging
Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches

https://doi.org/10.1016/j.jacc.2004.11.069Get rights and content
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Objectives

The aim of this research was to identify the diagnostic performance of gadolinium-enhanced and T2-weighted cardiovascular magnetic resonance (CMR) in suspected acute myocarditis.

Background

Acute myocarditis is difficult to diagnose; CMR provides various means to visualize myocardial inflammatory changes. A CMR approach with clear-cut diagnostic criteria would be desirable.

Methods

We investigated 25 patients with suspected acute myocarditis (18 males, 44 ± 17 years) and 23 healthy controls (13 males, 29 ± 10 years). Cardiovascular magnetic resonance studies included the following sequences: 1) T2-weighted triple inversion recovery; 2) T1-weighted spin echo before and over 4 min after gadolinium injection; and 3) inversion recovery-gradient echo 10 min after gadolinium injection. Qualitative and quantitative image analysis was performed for: 1) focal and global T2 signal intensity (SI); 2) myocardial global relative enhancement (gRE); and 3) areas of late gadolinium enhancement (LGE).

Results

Both global T2 SI and gRE were higher in patients than in controls (T2: 2.3 ± 0.4 vs. 1.7 ± 0.4; p < 0.0001, gRE: 6.8 ± 4.0 vs. 3.7 ± 2.3; p < 0.001). The sensitivity, specificity, and diagnostic accuracy for T2 (cutoff value of 1.9) were 84%, 74%, and 79%, respectively; gRE: (cutoff value of 4.0) 80%, 68%, and 74.5% respectively; LGE: 44%, 100%, and 71%, respectively. The best diagnostic performance was obtained when “any-two” of the three sequences were positive in the same patient yielding a 76% sensitivity, 95.5% specificity, and 85% diagnostic accuracy.

Conclusions

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.

Abbreviations and Acronyms

CK
creatine kinase
CMR
cardiovascular magnetic resonance
gRE
global relative enhancement
LGE
late gadolinium enhancement
SI
signal intensity

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