Ulf K Radunski1, Gunnar K Lund2, Dennis Säring3, Sebastian Bohnen4, Christian Stehning5, Bernhard Schnackenburg6, Maxim Avanesov2, Enver Tahir2, Gerhard Adam2, Stefan Blankenberg4, Kai Muellerleile4. 1. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. u.radunski@uke.de. 2. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Information Technology and Image Processing, University of Applied Sciences, Wedel, Germany. 4. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. 5. Philips Research Germany, Hamburg, Germany. 6. Philips Healthcare Germany, Hamburg, Germany.
Abstract
INTRODUCTION: This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance (CMR) to detect myocardial injury in apparently normal myocardium of patients with myocarditis. MATERIALS AND METHODS: We included 20 patients with "infarct-like" acute myocarditis who had typical focal myocardial lesions on late gadolinium enhancement (LGE) images as well as 20 healthy controls. The CMR protocol consisted of a standard myocarditis protocol which was combined with T1 (modified Look-Locker inversion recovery (MOLLI) with a 3(3)5 scheme and T2 mapping (hybrid gradient- and spin-echo multi-echo sequence, GraSE). First, LGE images were used to depict focal myocardial injury and apparently normal, remote myocardium. Second, native T1, T2 and ECV values were obtained in focal lesions but also in apparently normal myocardium. Third, native T1, T2 and ECV values ≥2 standard deviations above reference values obtained in healthy volunteers were used to quantify myocardial injury in patients with myocarditis. RESULTS: Apparently normal myocardium had significantly higher median native T1 [1095 (1055-1148) ms] and ECV [34 (32-35) %] values compared to reference values from healthy volunteers, which were 1051 (1021-1064) ms (p < 0.01) and 26 (24-27) % (p < 0.0001). Furthermore, a nonsignificant increase in median myocardial T2 was detected in apparently normal myocardium of patients with myocarditis compared to healthy volunteers [59 (55-65) vs. 56 (54-60) ms; p = 0.18]. Consequently, the amount of myocardial injury was significantly larger on native T1 [48 (32-56) %; p < 0.01] and ECV maps [58 (50-66) %; p < 0.01] compared to LGE [14 (9-20) %]. CONCLUSIONS: Native T1 and ECV maps reveal hidden myocardial injury in normal appearing myocardium of patients with myocarditis. The amount of myocardial injury in myocarditis was underestimated by conventional LGE imaging.
INTRODUCTION: This study evaluated the ability of T1 and T2 mapping cardiovascular magnetic resonance (CMR) to detect myocardial injury in apparently normal myocardium of patients with myocarditis. MATERIALS AND METHODS: We included 20 patients with "infarct-like" acute myocarditis who had typical focal myocardial lesions on late gadolinium enhancement (LGE) images as well as 20 healthy controls. The CMR protocol consisted of a standard myocarditis protocol which was combined with T1 (modified Look-Locker inversion recovery (MOLLI) with a 3(3)5 scheme and T2 mapping (hybrid gradient- and spin-echo multi-echo sequence, GraSE). First, LGE images were used to depict focal myocardial injury and apparently normal, remote myocardium. Second, native T1, T2 and ECV values were obtained in focal lesions but also in apparently normal myocardium. Third, native T1, T2 and ECV values ≥2 standard deviations above reference values obtained in healthy volunteers were used to quantify myocardial injury in patients with myocarditis. RESULTS: Apparently normal myocardium had significantly higher median native T1 [1095 (1055-1148) ms] and ECV [34 (32-35) %] values compared to reference values from healthy volunteers, which were 1051 (1021-1064) ms (p < 0.01) and 26 (24-27) % (p < 0.0001). Furthermore, a nonsignificant increase in median myocardial T2 was detected in apparently normal myocardium of patients with myocarditis compared to healthy volunteers [59 (55-65) vs. 56 (54-60) ms; p = 0.18]. Consequently, the amount of myocardial injury was significantly larger on native T1 [48 (32-56) %; p < 0.01] and ECV maps [58 (50-66) %; p < 0.01] compared to LGE [14 (9-20) %]. CONCLUSIONS: Native T1 and ECV maps reveal hidden myocardial injury in normal appearing myocardium of patients with myocarditis. The amount of myocardial injury in myocarditis was underestimated by conventional LGE imaging.
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