A fast and effective method to assess myocardial hyperemia in acute myocarditis by magnetic resonance

Abstract

Current cardiac magnetic resonance (CMR) quantitative signs for the diagnosis of myocarditis include myocardial edema, fibrosis and myocardial hyperemia (Hyp). Methods for the assessment of Hyp are actually complex and time-consuming. To test a simple and fast method to assess Hyp, using contrast enhancement steady state free precession (ceSSFP) technique. CMR imaging at 1.5T was performed on 39 patients with diagnosis of acute myocarditis and in 20 healthy controls. Hyp was evaluated in systolic and diastolic frames (Hyp-SYS and Hyp-DIA) as areas of myocardial hyperintensity in ceSSFP images early after gadolinium injection. Myocardial edema was evaluated using T2-STIR images. Myocardial fibrosis was assessed in conventional late gadolinium enhancement (LGE) images. A value of ≤12.1 g of Hyp-DIA was obtained as cut-off of normality in healthy controls. Using this threshold, Hyp was detected in 30 patients (77 %) with myocarditis. LGE was detected in 36 patients (92 %), and myocardial edema in 38 (97 %) patients with myocarditis A linear relation was found between Hyp-DIA and the extent of myocardial edema (R(2) 0.48, 95 % CI 0.47-0.85, p< 0.001) and the extent of LGE (R(2) 0.41, 95 % CI 0.31-0.61, p < 0.001). Patients with hyperemia had higher levels of C-reactive protein (p < 0.001), a higher extent of LGE (p < 0.05) and a larger left atrial area (p < 0.05). ceSSFP sequence at CMR is a novel and fast method to assess myocardial hyperemia in patient with acute myocarditis. Compared with non-Hyp subjects, patients with Hyp had more signs of inflammation and myocardial damage.

Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis

“…Hence, in patients with an increase in skeletal muscle signal intensity ≥ 20 %, as well as in patients with a recent history of muscular pain, an increase of > 45 % in absolute myocardial signal intensity between pre- and post-gadolinium images is suggested as a threshold consistent with myocarditis, rather than normalized EGEr [ 11 ]. An interesting alternative method for fast assessment of myocardial hyperemia in AM was recently reported, which relies on SSFP sequences acquired soon after contrast administration (ceSSFP) [ 24 ]. This approach overcomes most of the drawbacks of original FSE sequences and seems to be effective for the identification of areas of regional hyperemia, although it is not yet validated in patients with EMB-proven AM.…”

“…An interesting alternative method for fast assessment of myocardial hyperemia in AM was recently reported, which relies on SSFP sequences acquired soon after contrast administration (ceSSFP) [ 24 ]. This approach overcomes most of the drawbacks of original FSE sequences and seems to be effective for the identification of areas of regional hyperemia, although it is not yet validated in patients with EMB-proven AM.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…Cheng et al [44] studied the characteristics of patients with arrhythmogenic right ventricular cardiomyopathy with and without syncope and found that patients with syncope had significantly greater right and left end diastolic volume indices and incidence of LGE. A contrast enhanced steady state free precession technique was found to be useful for assessing for hyperemia in patients with acute myocarditis [45]. The impact of excluding the papillary muscles and trabeculae on RV volume and function was examined in two papers [46,47].…”

Clinical recommendations of cardiac magnetic resonance, Part II

“…1). 7,8 The sensitivity of CMR for the diagnosis of myocarditis is high for infarct-like presentation, low for myocarditis with heart failure and with arrhythmic clinical presentation. CMR findings should be used cautiously in these two latter conditions.…”