Diagnostic Performance of Extracellular Volume, Native T1, and T2 Mapping Versus Lake Louise Criteria by Cardiac Magnetic Resonance for Detection of Acute Myocarditis

Abstract

Native T1, T2, and ECV mapping provide comparable diagnostic performance to LLC. Although only native T1 had significantly better sensitivity than LLC, each technique offers distinct advantages for evaluating and characterizing myocarditis when compared with the LLC.

Myocarditis in Athletes Is a Challenge

“…T2 weighted imaging, T1 -and T2 mapping techniques LLC are now often complemented by novel CMR techniques such as native T1 and T2 mapping as well as extracellular volume fraction (ECV) measurement to provide a higher sensitivity and specificity (46,47). Native T1 mapping values are affected by both edema and extracellular expansion and is therefore able to detect myocarditis at various stages, whereas T2 mapping evaluates free water content that is normally present in the acute phase of myocarditis and then gradually normalizes over months -this is relevant for cardiac caregivers evaluating the course of myocarditis as it is the only technique that can adequately discriminate between myocarditis and noninflammatory cardiomyopathies in patients with symptoms lasting longer than 2 weeks (48,49). A recent meta-analysis by Pan et al (48) comparing the diagnostic performance of ECV, native T1 mapping and T2 mapping versus LLC for detection of acute myocarditis including 17 studies and 1308 subjects, has shown that only native T1 mapping had A c c e p t e d m a n u s c r i p t significantly better sensitivity than LLC, while other parameters had comparable diagnostic performance to LLC and provided distinct advantages for evaluating myocarditis.…”

Management and Treatment of Myocarditis in Athletes

“…With respect to myocarditis, CMR carries a sensitivity of 81%, a specificity of 71%, and a diagnostic accuracy of 79% (Table 1 ) [ 17 ]. Since 2009, the Lake Louise criteria has been the recommended imaging criteria for patients with suspected myocarditis [ 18 ]. It uses CMR markers that include T2-weighted (T2w) ratios, early gadolinium enhancement, and late gadolinium enhancement (LGE).…”

MRI in cardio‐oncology: A review of cardiac complications in oncologic care

“…With the advancements of native T 1 and T 2 mapping and ECV, however, the LCC have been challenged. A meta‐analysis performed by Pan et al found native T 1 , T 2 , and ECV mapping to provide comparable diagnostic performance to LLC with native T 1 having higher sensitivity of 85% than compared with the sensitivity of LCC of 74% to diagnose acute myocarditis …”

“…A meta-analysis performed by Pan et al found native T 1 , T 2 , and ECV mapping to provide comparable diagnostic performance to LLC with native T 1 having higher sensitivity of 85% than compared with the sensitivity of LCC of 74% to diagnose acute myocarditis. 86 Other Cardiac Complications Related to Cancer Therapy Advancements in MRI from parametric mapping to strain imaging have increased its utility to monitor CTRCD and cardiotoxicity, which can be seen within weeks of chemotherapy administration while patients are still asymptomatic. 87,88 However, cardiac MRI also plays a significant role in the diagnosis and management of other cardiac complications related to cancer care, including the diagnosis of cardiac thrombus, deposition diseases such as amyloidosis and hemochromatosis, and injury to the pericardium.…”