Advertisement

Cardiac magnetic resonance imaging: A non-invasive approach for the detection of myocardial inflammation — Potentials and limitations

  • Matthias Gutberlet
Part of the Progress in Inflammation Research book series (PIR)

Abstract

Cardiac magnetic resonance imaging (CMR) has evolved to the imaging modality of choice for the volumetric and functional evaluation of the heart in different cardiac diseases. Furthermore, it is capable of tissue characterization using T1- and T2-weighted images with and without the use of contrast agents. Therefore, it is the ideal imaging modality in cardiomyopathies or ischemic heart disease. Currently, the most commonly used CMR technique is the so-called delayed enhancement technique using T1-weighted inversion recovery sequences 10–15 min after the intravenous administration of a contrast agent, usually Gd-DTPA. With this technique viable myocardium can be distinguished from non-viable myocardium in ischemic heart disease, cardiomyopathies or myocarditis. Therefore, delayed myocardial enhancement is not specific for myocarditis, but a typical subepicardial or diffuse appearance allows for the differentiation between ischemic versus inflammatory heart disease. However, delayed myocardial enhancement represents more the irreversibly injured myocardium than inflammation itself. T2-weighted sequences and early myocardial enhancement using published ratios (edema ratio) or the global relative enhancement are best used for the detection of inflammation in comparison to results from endomyocardial biopsies, especially if used in combination. Simple evaluation of reduced global or regional ventricular function by magnetic resonance imaging is helpful for follow-up examinations but not very sensitive or specific for the diagnosis of myocarditis.

Keywords

Cardiovascular Magnetic Resonance Cardiac Magnetic Resonance Cardiac Magnetic Resonance Imaging Endomyocardial Biopsy Myocardial Edema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gagliardi MG, Bevilacqua M, Di Renzi P, Picardo S, Passariello R, Marcelletti C (1991) Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am J Cardiol 68(10): 1089–91CrossRefPubMedGoogle Scholar
  2. 2.
    Friedrich MG, Strohm O, Schulz-Menger J, Marciniak H, Luft FC, Dietz R (1998) Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation 97(18): 1802–9PubMedGoogle Scholar
  3. 3.
    Laissy JP, Messin B, Varenne O, Iung B, Karila-Cohen D, Schouman-Claeys E, Steg PG (2002) MRI of acute myocarditis: A comprehensive approach based on various imaging sequences. Chest 122(5): 1638–48CrossRefPubMedGoogle Scholar
  4. 4.
    Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D, Bock P, Dietz R, Friedrich MG, Schulz-Menger J (2005) Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: Comparison of different approaches. J Am Coll Cardiol 45(11): 1815–22CrossRefPubMedGoogle Scholar
  5. 5.
    Roditi GH, Hartnell GG, Cohen MC (2000) MRI changes in myocarditis — Evaluation with spin echo, cine MR angiography and contrast enhanced spin echo imaging. Clin Radiol 55(10): 752–8CrossRefPubMedGoogle Scholar
  6. 6.
    Rieker O, Mohrs O, Oberholzer K, Kreitner KF, Thelen M (2002) Cardiac MRI in suspected myocarditis. Röfo 174(12): 1530–6PubMedGoogle Scholar
  7. 7.
    Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H, Fritz P, Klingel K, Kandolf R, Sechtem U (2004) Cardiovascular magnetic resonance assessment of human myocarditis: A comparison to histology and molecular pathology. Circulation 109(10): 1250–8CrossRefPubMedGoogle Scholar
  8. 8.
    Mahrholdt H, Wagner A, Deluigi CC, Kispert E, Hager S, Meinhardt G, Vogelsberg H, Fritz P, Dippon J, Bock CT, Klingel K, Kandolf R, Sechtem U (2006) Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 114(15): 1581–90CrossRefPubMedGoogle Scholar
  9. 9.
    Laissy JP, Hyafil F, Feldman LJ, Juliard JM, Schouman-Claeys E, Steg PG, Faraggi M (2005) Differentiating acute myocardial infarction from myocarditis: Diagnostic value of early-and delayed-perfusion cardiac MR imaging. Radiology 237(1): 75–82CrossRefPubMedGoogle Scholar
  10. 10.
    Ingkanisorn WP, Paterson DI, Calvo KR, Rosing DR, Schwartzentruber DJ, Fuisz AR, Arai AE (2006) Cardiac magnetic resonance appearance of myocarditis caused by high dose IL-2: Similarities to community-acquired myocarditis. J Cardiovasc Magn Reson 8(2): 353–60CrossRefPubMedGoogle Scholar
  11. 11.
    De Cobelli F, Pieroni M, Esposito A, Chimenti C, Belloni E, Mellone R, Canu T, Perseghin G, Gaudio C, Maseri A, Frustaci A, Del Maschio A (2006) Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J Am Coll Cardiol 47(8): 1649–54CrossRefPubMedGoogle Scholar
  12. 12.
    Yelgec NS, Dymarkowski S, Ganame J, Bogaert J (2007) Value of MRI in patients with a clinical suspicion of acute myocarditis. Eur Radiol 17(9): 2211–7CrossRefPubMedGoogle Scholar
  13. 13.
    Noutsias M, Kuehl U, Lassner D, Gross U, Pauschinger M, Schultheiss HP, Gutberlet M (2007) Images in cardiovascular medicine. Parvovirus-B19-associated active myocarditis with biventricular thrombi. Results of endomyocardial biopsy investigations and cardiac magnetic resonance imaging. Circulation 115(13): e378–80CrossRefPubMedGoogle Scholar
  14. 14.
    Gutberlet M, Spors B, Thoma T, Bertram H, Denecke T, Felix R, Noutsias M, Schultheiss HP, Kühl U (2008) Suspected chronic myocarditis at cardiac MR: Diagnostic accuracy and association with immunohistologically detected inflammation and viral persistence. Radiology 246(2): 401–9CrossRefPubMedGoogle Scholar
  15. 15.
    Liu PP, Yan AT (2005) Cardiovascular magnetic resonance for the diagnosis of acute myocarditis: Prospects for detecting myocardial inflammation. J Am Coll Cardiol 45(11): 1823–5CrossRefPubMedGoogle Scholar
  16. 16.
    Skouri HN, Dec GW, Friedrich MG, Cooper LT (2006) Noninvasive imaging in myocarditis. J Am Coll Cardiol 48(10): 2085–93CrossRefPubMedGoogle Scholar
  17. 17.
    Magnani JW, Dec GW (2006) Myocarditis: Current trends in diagnosis and treatment. Circulation 113(6): 876–90CrossRefPubMedGoogle Scholar
  18. 18.
    Ammann P, Naegeli B, Schuiki E, Mury R, Frielingsdorf J, Bertel O (2003) Long-term outcome of acute myocarditis is independent of initial cardiac enzyme release. Int J Cardiol 89(2–3): 217–22PubMedGoogle Scholar
  19. 19.
    Kishimoto C, Hiraoka Y (1994) Clinical and experimental studies in myocarditis. Curr Opin Cardiol 9(3): 349–56CrossRefPubMedGoogle Scholar
  20. 20.
    Simonetti OP, Finn JP, White RD, Laub G, Henry DA (1996) “Black blood” T2-weighted inversion recovery MR imaging of the heart. Radiology 199(1): 49–57PubMedGoogle Scholar
  21. 21.
    Kellman P, Aletras AH, Mancini C, McVeigh ER, Arai AE (2007) T2-prepared SSFP improves diagnostic confidence in edema imaging in acute myocardial infarction compared to turbo spin echo. Magn Reson Med 57(5): 891–7CrossRefPubMedGoogle Scholar
  22. 22.
    Miller DD, Holmvang G, Gill JB, Dragotakes D, Kantor HL, Okada RD, Brady TJ (1989) MRI detection of myocardial perfusion changes by gadolinium-DTPA infusion during dipyridamole herperemia. Magn Reson Med 10(2): 246–55CrossRefPubMedGoogle Scholar
  23. 23.
    Paajanen H, Brasch RC, Schmiedl U, Ogan M (1987) Magentic resonance imaging of local tissue inflammation using gadolinium-DTPA. Acta Radiol 28(1): 79–83CrossRefPubMedGoogle Scholar

Copyright information

© Springer Basel 2010

Authors and Affiliations

  • Matthias Gutberlet
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Leipzig/ Leipzig Heart CenterLeipzigGermany

Personalised recommendations