Rocio Hinojar1, Lucy Foote1, Eduardo Arroyo Ucar1, Thomas Jackson1, Andrew Jabbour2, Chung-Yao Yu2, Jane McCrohon2, David M Higgins3, Gerry Carr-White4, Manuel Mayr5, Eike Nagel1, Valentina O Puntmann6. 1. Cardiovascular Imaging Department, Division of Imaging Sciences, King's College London, London, United Kingdom. 2. St. Vincent's Hospital and the Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia. 3. Philips Healthcare, Guildford, United Kingdom. 4. Guys and St. Thomas' NHS Trust, London, United Kingdom. 5. Cardiovascular Division, King's College London, London, United Kingdom. 6. Cardiovascular Imaging Department, Division of Imaging Sciences, King's College London, London, United Kingdom. Electronic address: v.puntmann@kcl.ac.uk.
Abstract
OBJECTIVES: This study investigated whether T1 mapping by cardiac magnetic resonance (CMR) reflects the clinical evolution of disease in myocarditis and supports its diagnosis independently of the disease stages. BACKGROUND: Acute viral myocarditis is characterized by a range of intracellular changes due to viral replication and extracellular spill of debris within days of viral infection. Convalescence may be characterized by a chronic low-grade inflammation leading to ventricular remodelling, but also a complete resolution of myocardial changes. METHODS: Patients with clinical diagnosis of viral myocarditis (N = 165) underwent routine clinical CMR protocol (1.5- and 3.0-T) for assessment of cardiac function and structure, and tissue characterization with T2-weighted imaging and late gadolinium enhancement. T1 mapping was obtained in a mid-ventricular short-axis slice before and >20 min after administration of 0.2 mmol/kg of gadobutrol. RESULTS: Compared with control subjects (n = 40), T1 indexes were increased in patients with myocarditis. Patients with acute symptoms (n = 61) had higher values of T1 indexes compared with patients in clinical convalescence (n = 67). Native T1 is an independent discriminator between health and disease, as well as a discriminator between acute and convalescent stage of the disease. Native T1- was superior to T2-weighted imaging and late gadolinium enhancement with high diagnostic accuracy and positive and negative predictive values. Using pre-defined cutoff values for normal ranges, we demonstrated that acute myocarditis can be independently identified by native T1 of >5 SD above the mean of normal range, whereas convalescence is best defined by either abnormal native T1 (>2 SD) or presence of late gadolinium enhancement. We prospectively tested a new diagnostic algorithm in an independent dataset of patients with clinical diagnosis of myocarditis and achieved similar diagnostic performance. CONCLUSIONS: The new diagnostic algorithm using native T1 can reliably discriminate between health and disease and determine the clinical disease stage in patients with a clinical diagnosis of myocarditis.
OBJECTIVES: This study investigated whether T1 mapping by cardiac magnetic resonance (CMR) reflects the clinical evolution of disease in myocarditis and supports its diagnosis independently of the disease stages. BACKGROUND: Acute viral myocarditis is characterized by a range of intracellular changes due to viral replication and extracellular spill of debris within days of viral infection. Convalescence may be characterized by a chronic low-grade inflammation leading to ventricular remodelling, but also a complete resolution of myocardial changes. METHODS: Patients with clinical diagnosis of viral myocarditis (N = 165) underwent routine clinical CMR protocol (1.5- and 3.0-T) for assessment of cardiac function and structure, and tissue characterization with T2-weighted imaging and late gadolinium enhancement. T1 mapping was obtained in a mid-ventricular short-axis slice before and >20 min after administration of 0.2 mmol/kg of gadobutrol. RESULTS: Compared with control subjects (n = 40), T1 indexes were increased in patients with myocarditis. Patients with acute symptoms (n = 61) had higher values of T1 indexes compared with patients in clinical convalescence (n = 67). Native T1 is an independent discriminator between health and disease, as well as a discriminator between acute and convalescent stage of the disease. Native T1- was superior to T2-weighted imaging and late gadolinium enhancement with high diagnostic accuracy and positive and negative predictive values. Using pre-defined cutoff values for normal ranges, we demonstrated that acute myocarditis can be independently identified by native T1 of >5 SD above the mean of normal range, whereas convalescence is best defined by either abnormal native T1 (>2 SD) or presence of late gadolinium enhancement. We prospectively tested a new diagnostic algorithm in an independent dataset of patients with clinical diagnosis of myocarditis and achieved similar diagnostic performance. CONCLUSIONS: The new diagnostic algorithm using native T1 can reliably discriminate between health and disease and determine the clinical disease stage in patients with a clinical diagnosis of myocarditis.
Authors: Sen Ma; Christopher T Nguyen; Fei Han; Nan Wang; Zixin Deng; Nader Binesh; Franklin G Moser; Anthony G Christodoulou; Debiao Li Journal: Magn Reson Med Date: 2019-11-25 Impact factor: 4.668
Authors: Florian André; Florian T Stock; Johannes Riffel; Evangelos Giannitsis; Henning Steen; Jürgen Scharhag; Hugo A Katus; Sebastian J Buss Journal: Int J Cardiovasc Imaging Date: 2016-04-21 Impact factor: 2.357
Authors: Julian A Luetkens; Rami Homsi; Alois M Sprinkart; Jonas Doerner; Darius Dabir; Daniel L Kuetting; Wolfgang Block; René Andrié; Christian Stehning; Rolf Fimmers; Juergen Gieseke; Daniel K Thomas; Hans H Schild; Claas P Naehle Journal: Eur Heart J Cardiovasc Imaging Date: 2015-10-16 Impact factor: 6.875