Cardiac MRI and Texture Analysis of Myocardial T1 and T2 Maps in Myocarditis with Acute versus Chronic Symptoms of Heart Failure

Abstract

yocarditis is the leading cause of heart failure in individuals under 40 years of age (1). It frequently leads to dilated cardiomyopathy (2) and represents one of the most challenging diagnoses in clinical cardiology. Growing clinical evidence exists that myocarditis is a multifaceted disease, where different subtypes can be differentiated based on the predominant clinical presentation (3). Consequently, the diagnostic approach for myocarditis manifesting with symptoms of heart failure (heart failure-like myocarditis) should be different from myocarditis with acute infarctlike presentation (3-6). Establishing the timely and correct diagnosis, especially in individuals with heart failure-like myocarditis, is of importance because these individuals might benefit from a tailored therapeutic strategy. However, the primary tools for noninvasive diagnosis of myocarditis, including cardiac MRI and diagnostic requirements as defined by the Lake Louise criteria, have been shown to exhibit a very limited diagnostic accuracy in heart failurelike and chronic myocarditis (3-7). Recently, T1 and T2 mapping techniques have been introduced as quantitative approaches for a more reliable

Diagnosis of Myocarditis at Cardiac MRI: The Continuing Quest for Improved Tissue Characterization

“…Although some limitations remain, texture analysis of images from cardiac MRI performed better than Lake Louise criteria and T1 and T2 mapping in this cohort of patients with acute and chronic heart failure-like myocarditis (7). The naming of features of texture analysis is difficult to comprehend, but Baessler et al provide some explanation to understand their significance.…”

“…To order printed copies, contact reprints@rsna.org (92%) in the diagnosis of acute infarctlike myocarditis, outperforming Lake Louise criteria and native T1 and T2 measurements of the myocardium. In this issue of Radiology, Baessler et al (7) applied texture analysis to myocardial T1 and T2 maps of myocarditis with acute and chronic symptoms of heart failure. Their study expands on the experience of using texture analysis in the setting of acute versus chronic myocarditis manifesting with heart failure.…”

“…In their prospective study, 31 participants with acute (,14 days of symptoms) heart failure-like myocarditis and 40 patients with chronic (.14 days of symptoms) heart failurelike myocarditis underwent cardiac MRI to test the diagnostic utility of texture analysis. Endomyocardial biopsy was used as the reference standard (7). For comparison, native T1 mapping, T2 mapping, and Lake Louise criteria were evaluated.…”

Cardiac radiomics: an interactive approach for 4D data exploration

“…Previous studies analyzed the applicability of CMR-based radiomics approaches for disease classification with cine MRI [7,8], and CMR T1 and T2 sequences [9]. The authors could identify suitable shape, intensity and texture features for the recognition of diseases such as myocardial infarction.…”

Artificial Intelligence and Cardiovascular Imaging. A win-win Combination

“…Furthermore, recent studies suggest that TA can differentiate among various causes of myocardial hypertrophy ( 40 ). Finally, TA applied on CMR T 1 and T 2 mapping proves to be an efficient tool in diagnosing myocarditis ( 41 ).…”