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Cardiac magnetic resonance imaging: diagnostic value and utility in the follow-up of patients with acute myocarditis mimicking myocardial infarction

Valore diagnostico ed utilità nel follow-up della risonanza magnetica cardiaca nei pazienti con miocardite acuta e sintomi clinici che simulano un infarto acuto del miocardio

  • Cardiac Radiology Cardioradiologia
  • Published:
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Abstract

Purpose

The aim of our study was to evaluate the efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between active myocarditis and myocardial infarction in patients with clinical symptoms mimicking acute myocardial infarction.

Materials and methods

Between 1 January 2006 and 30 June 2007, 23 consecutive patients (21 men and 2 women) presenting with electrocardiographic abnormalities mimicking acute myocardial infarction and a clinical suspicion of acute myocarditis (fever, chest pain and elevated troponin levels) underwent contrast-enhanced cardiac MRI within a week of admission. All patients also underwent coronary angiography, which demonstrated the absence of significant coronary artery lesions. The mean follow-up period was 2±4 months.

Results

Cardiac MRI with injection of contrast material showed late subepicardial and intramyocardial enhancement in all patients. Subendocardial late enhancement, a typical pattern of myocardial infarction, was never seen. In addition, in agreement with the literature, there was prevalent involvement of the lateral segments of the left ventricular wall.

Conclusions

Cardiac MRI could be a valuable tool for the early diagnosis of acute myocarditis, as it can demonstrate specific patterns that help rule out acute myocardial infarction.

Riassunto

Obiettivo

Scopo dello studio è dimostrare l’efficacia diagnostica della risonanza magnetica cardiaca nella diagnosi differenziale tra miocardite acuta ed infarto miocardico,in pazienti con quadro clinico simil-infartuale.

Materiali e metodi

Dal 1 gennaio 2006 al 30 giugno 2007, ventitre pazienti consecutivi ricoverati con alterazioni elettrocardiografiche di tipo simil-infartuale (stemi) e sospetto clinico di miocardite acuta (febbre, dolore toracico, positività dei valori di troponina) sono stati sottoposti, entro 6 giorni dall’esordio, a risonanza magnetica (RM) cardiaca con MdC. Tutti i pazienti sono stati sottoposti a coronarografia, che non ha evidenziato lesioni a carico delle coronarie. La maggioranza dei pazienti erano uomini (21 uomini, 2 donne). L’intervallo medio per il follow-up è stato di 2±4 mesi.

Risultati

La RM con MdC ha evidenziato in tutti i pazienti la presenza di late enhancement (LE) a primitiva sede subepicardica o intra-miocardica. In nessun caso si è riscontrata presenza di LE sub-endocardico, quadro tipico della necrosi a genesi ischemica. Inoltre, in accordo con quanto riportato in letteratura, prevalente è stato l’interessamento dei segmenti laterali della parete del ventricolo sinistro rispetto alle altre pareti.

Conclusioni

La RM cardiaca può avere ruolo fondamentale nella diagnosi precoce di miocardite acuta, documentando un quadro di alterazioni di segnale del miocardio che esclude la genesi ischemica.

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Authors and Affiliations

  1. U.O.C. di Radiodiagnostica, Ospedale M.G.Vannini, Via Dell’Acqua Bullicante 4, Roma, Italy

    M. Danti, S. Sbarbati, N. Alsadi, A. Di Filippo, G. Gangitano, L. Giglio, V. Salvini, M. Amoruso & S. Della Sala

  2. U.O.C. di Cardiologia, Ospedale M.G.Vannini, Via Dell’Acqua Bullicante 4, Roma, Italy

    G. S. Camastra & G. Ansalone

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  1. M. Danti
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  2. S. Sbarbati
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  3. N. Alsadi
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  4. A. Di Filippo
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  5. G. Gangitano
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  6. L. Giglio
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  7. V. Salvini
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  10. G. Ansalone
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  11. S. Della Sala
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Correspondence to M. Danti.

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Danti, M., Sbarbati, S., Alsadi, N. et al. Cardiac magnetic resonance imaging: diagnostic value and utility in the follow-up of patients with acute myocarditis mimicking myocardial infarction. Radiol med 114, 229–238 (2009). https://doi.org/10.1007/s11547-008-0353-7

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  • DOI: https://doi.org/10.1007/s11547-008-0353-7

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