Myocarditis MRI: Difference between revisions
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Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed [[gadolinium]] [[hyperenhancement]] on [[cardiac MRI]] ([[cMRI]]). <ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref>. While the [[cMRI]] pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the [[subendocardium]]<ref>{{cite journal |author=Skouri HN, Dec GW, Friedrich MG, Cooper LT |title=Noninvasive imaging in myocarditis |journal=J. Am. Coll. Cardiol. |volume=48 |issue=10 |pages=2085-93 |year=2006 |pmid=17112998 |doi=10.1016/j.jacc.2006.08.017}}</ref>. | Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed [[gadolinium]] [[hyperenhancement]] on [[cardiac MRI]] ([[cMRI]]). <ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref>. While the [[cMRI]] pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the [[subendocardium]]<ref>{{cite journal |author=Skouri HN, Dec GW, Friedrich MG, Cooper LT |title=Noninvasive imaging in myocarditis |journal=J. Am. Coll. Cardiol. |volume=48 |issue=10 |pages=2085-93 |year=2006 |pmid=17112998 |doi=10.1016/j.jacc.2006.08.017}}</ref>. | ||
When used in conjunction with the findings on coronary angiography, cMRI is useful in distinguishing between a diagnosis of myocarditis and myonecrosis associated with myocardial ischemia. Among 79 patients with elevated [[cardiac biomakrkers]] who were suspected of having [[ACS]] and had normal [[coronary arteries]] on [[coronary angiography]], 81% of the patients (including those with preserved [[ejection fraction]]) were diagnosed with [[myocarditis]] based on cMRI findings<ref name="pmid21106555">{{cite journal| author=Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A et al.| title=Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis. | journal=Heart | year= 2011 | volume= 97 | issue= 16 | pages= 1312-8 | pmid=21106555 | doi=10.1136/hrt.2010.204818 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106555 }} </ref>. | |||
Gadolinium-enhanced magnetic resonance imaging (MRI) | ==Myocardial Edema== | ||
Gadolinium-enhanced magnetic resonance imaging (MRI) may alsoaid in assessing the extent of myocardial edema and the extent of myocardial scarring <ref name="pmid19898290">{{cite journal| author=Al-Mallah M, Kwong RY| title=Clinical application of cardiac CMR. | journal=Rev Cardiovasc Med | year= 2009 | volume= 10 | issue= 3 | pages= 134-41 | pmid=19898290 | doi= | pmc= | url= }} </ref>. | |||
==Sensitivity and Specificity== | |||
CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref>. | CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref>. | ||
*Focal and global T2 signal intensity | *Focal and global T2 signal intensity | ||
Revision as of 15:29, 11 September 2011
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Myocarditis MRI On the Web |
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American Roentgen Ray Society Images of Myocarditis MRI |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.
Overview
Cardiac MRI findings associated with myocarditis include myocardial inflammation, myocardial edema, capillary leak, and reduced left ventricular function.
Myocardial Inflammation
Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed gadolinium hyperenhancement on cardiac MRI (cMRI). [1]. While the cMRI pattern of gadolinium hyperenhancement in ST segment elevation myocardial infarction is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in myocarditis in contrast involves the epicardium and spares the subendocardium[2].
When used in conjunction with the findings on coronary angiography, cMRI is useful in distinguishing between a diagnosis of myocarditis and myonecrosis associated with myocardial ischemia. Among 79 patients with elevated cardiac biomakrkers who were suspected of having ACS and had normal coronary arteries on coronary angiography, 81% of the patients (including those with preserved ejection fraction) were diagnosed with myocarditis based on cMRI findings[3].
Myocardial Edema
Gadolinium-enhanced magnetic resonance imaging (MRI) may alsoaid in assessing the extent of myocardial edema and the extent of myocardial scarring [4].
Sensitivity and Specificity
CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used[1].
- Focal and global T2 signal intensity
- Myocardial global relative enhancement
- Delayed gadolinium enhancement
On CMR, inflammatory regions of cardia in myocarditis appear as contrast-enhanced regions. These are often observed on lateral and inferior walls and can be used to guide biopsy. Among 21 patients who underwent biopsy of contrast enhanced regions in a series in Germany, histopathologic findings in 19 patients were consistent with myocarditis[5].
CMR in myocarditis is generally indicated in patients with new or persisting symptoms, evidence for significant myocardial injury, and suspected viral etiology[6].
CMR findings in Myocarditis[6]:
- High T2 signal intensity areas suggests edema.
- Myocardial early gadolinium enhancement ratio (ratio between myocardium and skeletal muscle) ≥4.0 is suggestive of hyperemia and capillary leakage.
- Areas of delayed gadolinium enhancement suggesting myocardial injury or inflammation.
- Systolic dysfunction and pericardial effusion may also be noted on CMR
References
- ↑ 1.0 1.1 Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D; et al. (2005). "Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches". J Am Coll Cardiol. 45 (11): 1815–22. doi:10.1016/j.jacc.2004.11.069. PMID 15936612.
- ↑ Skouri HN, Dec GW, Friedrich MG, Cooper LT (2006). "Noninvasive imaging in myocarditis". J. Am. Coll. Cardiol. 48 (10): 2085–93. doi:10.1016/j.jacc.2006.08.017. PMID 17112998.
- ↑ Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A; et al. (2011). "Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis". Heart. 97 (16): 1312–8. doi:10.1136/hrt.2010.204818. PMID 21106555.
- ↑ Al-Mallah M, Kwong RY (2009). "Clinical application of cardiac CMR". Rev Cardiovasc Med. 10 (3): 134–41. PMID 19898290.
- ↑ Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H; et al. (2004). "Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology". Circulation. 109 (10): 1250–8. doi:10.1161/01.CIR.0000118493.13323.81. PMID 14993139.
- ↑ 6.0 6.1 Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT; et al. (2009). "Cardiovascular magnetic resonance in myocarditis: A JACC White Paper". J Am Coll Cardiol. 53 (17): 1475–87. doi:10.1016/j.jacc.2009.02.007. PMC 2743893. PMID 19389557.