Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis
<b>(1) Background:</b> Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. <b>(2) Objectives:</b>...
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| Format: | Article |
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MDPI AG
2022-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/17/5113 |
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| author | Jan M. Brendel Karin Klingel Jens Kübler Karin A. L. Müller Florian Hagen Meinrad Gawaz Konstantin Nikolaou Simon Greulich Patrick Krumm |
| author_facet | Jan M. Brendel Karin Klingel Jens Kübler Karin A. L. Müller Florian Hagen Meinrad Gawaz Konstantin Nikolaou Simon Greulich Patrick Krumm |
| author_sort | Jan M. Brendel |
| collection | DOAJ |
| description | <b>(1) Background:</b> Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. <b>(2) Objectives:</b> To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. <b>(3) Methods:</b> 48 patients (age 37 (IQR 28–55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (<i>n</i> = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (<i>n</i> = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T<sub>1</sub>, ECV, T<sub>2</sub>). <b>(4) Results:</b> Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T<sub>1</sub> mapping (applying a segmental or global increase of native T<sub>1</sub> > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T<sub>2</sub> (AUC 0.66). <b>(5) Conclusions:</b> A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T<sub>1</sub> mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings. |
| first_indexed | 2024-03-10T01:39:48Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:39:48Z |
| publishDate | 2022-08-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-e18e1a22e0a74b2db95441d323db35732023-11-23T13:27:47ZengMDPI AGJournal of Clinical Medicine2077-03832022-08-011117511310.3390/jcm11175113Comprehensive Cardiac Magnetic Resonance to Detect Subacute MyocarditisJan M. Brendel0Karin Klingel1Jens Kübler2Karin A. L. Müller3Florian Hagen4Meinrad Gawaz5Konstantin Nikolaou6Simon Greulich7Patrick Krumm8Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, GermanyCardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, Liebermeisterstraße 8, 72076 Tübingen, GermanyDepartment of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, GermanyDepartment of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, GermanyDepartment of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, GermanyDepartment of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, GermanyDepartment of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, GermanyDepartment of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, GermanyDepartment of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany<b>(1) Background:</b> Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. <b>(2) Objectives:</b> To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. <b>(3) Methods:</b> 48 patients (age 37 (IQR 28–55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (<i>n</i> = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (<i>n</i> = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T<sub>1</sub>, ECV, T<sub>2</sub>). <b>(4) Results:</b> Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T<sub>1</sub> mapping (applying a segmental or global increase of native T<sub>1</sub> > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T<sub>2</sub> (AUC 0.66). <b>(5) Conclusions:</b> A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T<sub>1</sub> mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings.https://www.mdpi.com/2077-0383/11/17/5113acute myocarditissubacute myocarditismagnetic resonance imagingCMRLGET<sub>1</sub> mapping |
| spellingShingle | Jan M. Brendel Karin Klingel Jens Kübler Karin A. L. Müller Florian Hagen Meinrad Gawaz Konstantin Nikolaou Simon Greulich Patrick Krumm Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis Journal of Clinical Medicine acute myocarditis subacute myocarditis magnetic resonance imaging CMR LGE T<sub>1</sub> mapping |
| title | Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis |
| title_full | Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis |
| title_fullStr | Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis |
| title_full_unstemmed | Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis |
| title_short | Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis |
| title_sort | comprehensive cardiac magnetic resonance to detect subacute myocarditis |
| topic | acute myocarditis subacute myocarditis magnetic resonance imaging CMR LGE T<sub>1</sub> mapping |
| url | https://www.mdpi.com/2077-0383/11/17/5113 |
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