Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified “Infarct-like Myocarditis”

Abstract

Purpose: Cardiac magnetic resonance (CMR) has increasingly proved to be a valuable diagnostic tool for evaluating patients with suspected myocarditis. The objective of this study was to evaluate the diagnostic value of functional and morphological parameters including tissue characterization in patients with “infarct-like myocarditis”.

Materials and Methods: 43 patients with clinically verified cases of “infarct-like myocarditis” (median time to MRI scanning after admission for acute symptoms 3 days) and 35 control patients matched by age and sex were included in this retrospective case control study. In this study we used a 1.5 T MRI scanner conducting steady-state-free-precession sequences, T2-weighted imaging, T1-weighted imaging before and after contrast administration and late gadolinium enhancement sequences. According to the recommendations for CMR diagnosis of myocarditis (Lake Louise consensus criteria), a scan was positive for acute myocarditis if 2 of 3 CMR criteria were present.

Results: 30 % of the patients with “infarct-like myocarditis” had a reduced left ventricular ejection fraction, 11 % had an increased LV end-diastolic volume index and 35 % had an increased LV mass index. The sensitivity of wall motion abnormalities was 63 % with a regional distribution in 49 %. In 47 % of cases regional wall motion abnormalities were present in the lateral left ventricular segments. Pericardial effusions were discovered in 65 % of cases with a circular appearance in 21 % and focal manifestation in 44 %. The diagnostic sensitivity, specificity, and accuracy of CMR in patients with “infarct-like myocarditis” were 67 %, 100 % and 82 %, respectively. The LGE alone was the most sensitive test parameter with 86 %, providing a specificity of 100 % and accuracy of 92 %.

Conclusion: Our study results can be applied to the subgroup of patients with “infarct-like myocarditis”, where we found that LGE alone was the most sensitive test parameter. In addition to tissue characterization, the functional and morphological analysis of patients with acute myocarditis provides a useful further diagnostic tool.

Key Points:

• Infarct-like myocarditis can be diagnosed by CMR with high validity and reliability.

• LGE allone performed best with a sensitivity of 86 %.

• Functional and morphological CMR parameters in addition to tissue characterization are useful tool in the diagnosis of acute myocarditis.

Citation Format:

• Schwab J, Rogg H-J, Pauschinger M et al. Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified “Infarct-like Myocarditis”. Fortschr Röntgenstr 2016; 188: 365 – 373

Zusammenfassung

Ziel: Die kardiovaskuläre Magnetresonanztomografie (CMR) hat sich in den letzten Jahren zunehmend als wertvolles diagnostisches Verfahren herausgestellt. Ziel der vorliegenden Arbeit war es, den diagnostischen Wert funktioneller und morphologischer Parameter einschließlich der Gewebecharkaterisierung bei Patienten mit „infarct-like myocarditis“ zu erfassen.

Material und Methoden: In einer retrospektiven Fall-Kontroll-Studie wurden 43 Patienten mit klinisch gesicherter „infarct-like myocarditis“ (medianer Zeitraum von Klinikaufnahme mit akuten Symptomen bis zur MRT-Untersuchung 3 Tage) und 35 nach Alter und Geschlecht gematchte Kontrollpersonen eingeschlossen. Die Untersuchungen wurden an einem 1,5 T-Gerät unter Anwendung der steady-state-free-precession-Sequenzen, T2 gewichteter bzw. T1 gewichteter Bildgebung vor und nach Kontrastmittelapplikation und Late-Gadolinium-Enhancement-Sequenzen durchgeführt. Gemäß der Consensusvereinbarungen (Lake-Louise-Kriterien) lag eine Myokarditis vor, wenn 2 von 3 CMR-Techniken positiv ausfielen.

Ergebnisse: Es fanden sich bei 30 % der Patienten mit „infarct-like myocarditis“ eine reduzierte LVEF, ein erhöhter LVEDVI bei 11 %, sowie eine Zunahme des LVMI bei 35 %. Die Sensitivität von Wandbewegungsstörungen betrug 63 %. Regionale Wandbewegungsstörungen traten bei 49 % auf, wobei diese in 47 % in den lateralen linksventrikulären Segmenten vorlagen. Perikardergüsse wurden in 65 % beobachtet, mit zirkulärer Manifestation in 21 % und fokaler in 44 %. Die Sensitivität, Spezifität, und diagnostische Genauigkeit der CMR bei den Patienten mit „infarct-like myocarditis“ betrug 67 %, 100 % und 82 %. Bei der LGE-Sequenz als alleinigem Testparameter fanden sich die höchsten Werte mit 86 %, 100 % und 92 %.

Schlussfolgerung: Die Ergebnisse der vorliegenden Studie beziehen sich auf eine Subgruppe mit Patienten mit „infarct-like myocarditis“, in der sich das LGE alleine als der sensitivste Testparameter herausstellte. Die Analyse der funktionellen und morphologischen Parameter stellt neben der Gewebecharakterisierung eine sinnvolle Ergänzung der Diagnostik bei der akuten Myokarditis dar.

Kernaussagen:

• Die „infarct-like myocarditis“ kann mittels CMR valide diagnostiziert werden.

• Bester Testparameter ist das LGE alleine mit einer Sensitivität von 86 %

• Funktionelle und morphologische CMR-Parameter stützen die Diagnose einer akuten Myokarditis in Ergänzung zur Gewebecharakterisierung.

Key words

inflammation - heart - MR imaging

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