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

  • Massimo Imbriaco
  • Carmela Nappi
  • Marta Puglia
  • Marco De Giorgi
  • Serena Dell’Aversana
  • Renato Cuocolo
  • Andrea Ponsiglione
  • Igino De Giorgi
  • Maria Vincenza Polito
  • Michele Klain
  • Federico Piscione
  • Leonardo Pace
  • Alberto Cuocolo
Original Article

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.

Keywords

Myocarditis cardiac imaging magnetic resonance imaging 

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

Notes

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.

Supplementary material

12350_2017_1109_MOESM1_ESM.pptx (2.5 mb)
Supplementary material 1 (PPTX 2563 kb)

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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Massimo Imbriaco
    • 1
  • Carmela Nappi
    • 1
  • Marta Puglia
    • 1
  • Marco De Giorgi
    • 2
  • Serena Dell’Aversana
    • 1
  • Renato Cuocolo
    • 1
  • Andrea Ponsiglione
    • 1
  • Igino De Giorgi
    • 3
  • Maria Vincenza Polito
    • 2
  • Michele Klain
    • 1
  • Federico Piscione
    • 2
  • Leonardo Pace
    • 2
  • Alberto Cuocolo
    • 1
  1. 1.Department of Advanced Biomedical SciencesUniversity of Naples “Federico II”NaplesItaly
  2. 2.Department of Medicine and SurgeryUniversity of SalernoSalernoItaly
  3. 3.Department of Diagnostic Imaging and RadiotherapyA.O. San Giovanni di Dio e Ruggi d’AragonaSalernoItaly

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