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Assessment of acute myocarditis by cardiac magnetic resonance imaging: Comparison of qualitative and quantitative analysis methods

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM).

Methods

A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE). Diagnostic performance was assessed for each method by measuring the area under the curves (AUC) of the receiver operating characteristic analyses. The final diagnosis of AM was based on symptoms and signs suggestive of cardiac disease, evidence of myocardial injury as defined by electrocardiogram changes, elevated troponin I, exclusion of coronary artery disease by coronary angiography, and clinical and echocardiographic follow-up at 3 months after admission to the chest pain unit.

Results

In all patients, coronary angiography did not show significant coronary artery stenosis. Troponin I levels and creatine kinase were higher in patients with AM compared to those without (both P < .001). There were no significant differences among LLC, T2-weighted short inversion time inversion recovery (STIR) sequences, early (EGE), and late (LGE) gadolinium-enhancement sequences for diagnosis of AM. The AUC for qualitative (T2-weighted STIR 0.92, EGE 0.87 and LGE 0.88) and quantitative (ER 0.89 and global RE 0.80) analyses were also similar.

Conclusions

Qualitative and quantitative CMR analysis methods show similar diagnostic accuracy for the diagnosis of AM. These findings suggest that a simplified approach using a shortened CMR protocol including only T2-weighted STIR sequences might be useful to rule out AM in patients with acute coronary syndrome and normal coronary angiography.

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Abbreviations

AM:

Acute myocarditis

CMR:

Cardiac magnetic resonance

LLC:

Lake-Louise Criteria

EGE:

Early gadolinium-enhancement

LGE:

Late gadolinium-enhancement

STIR:

Short time inversion recovery

ER:

Edema ratio

RE:

Relative enhancement

ROI:

Region of interest

AUC:

Area under the curve

ROC:

Receiver operating characteristic

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Disclosure

M. Imbriaco, C. Nappi, M. Puglia, M. De Giorgi, S. Dell’Aversana, R. Cuocolo, A. Ponsiglione, I. De Giorgi, M.V. Polito, M. Klain, F. Piscione, L. Pace, A. Cuocolo declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy

    Massimo Imbriaco MD, Carmela Nappi MD, Marta Puglia MD, Serena Dell’Aversana MD, Renato Cuocolo MD, Andrea Ponsiglione MD, Michele Klain MD & Alberto Cuocolo MD

  2. Department of Medicine and Surgery, University of Salerno, Salerno, Italy

    Marco De Giorgi MD, Maria Vincenza Polito MD, Federico Piscione MD & Leonardo Pace MD

  3. Department of Diagnostic Imaging and Radiotherapy, A.O. San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Igino De Giorgi MD

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  1. Massimo Imbriaco MD
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Correspondence to Massimo Imbriaco MD.

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Imbriaco, M., Nappi, C., Puglia, M. et al. Assessment of acute myocarditis by cardiac magnetic resonance imaging: Comparison of qualitative and quantitative analysis methods. J. Nucl. Cardiol. 26, 857–865 (2019). https://doi.org/10.1007/s12350-017-1109-3

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  • DOI: https://doi.org/10.1007/s12350-017-1109-3

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