Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters

Abstract

ObjectiveTo evaluate the role of MRI in diagnosing acute myocarditis by correlation with immunohistological parameters.MethodsA total of 131 patients (85 men, 46 women; mean age, 44.9 years) with suspected acute myocarditis were examined by MRI. The relative water content of the left ventricular myocardium as well as relative and late enhancement was correlated with the immunohistological results in biopsy specimens.ResultsMyocardial inflammation was confirmed by immunohistology in 82 of the 131 patients investigated and ruled out in 49 patients. The sensitivity, specificity and accuracy for diagnosing myocarditis in patients with immunohistologically proven disease were 48.8%, 73.8% and 57.3%, respectively, for relative enhancement, 58.3%, 57.1% and 57.9% for relative water content, and 30.6%, 88.1% and 49.6% for late enhancement. A combination of all three parameters had 39,3% sensitivity and 91,3% specificity and 62,7% accuracy. Relative enhancement and late enhancement significantly correlated with the presence of myocarditis but relative oedema did not.ConclusionRelative and late enhancement significantly correlate with the presence of myocarditis, while there is no significant correlation for relative oedema. Myocarditis cannot be reliably diagnosed using any of the three MRI parameters alone but combinations of parameters will improve specificity.

Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified “Infarct-like Myocarditis”

“…The diagnostic performance of T2-weighted imaging alone for the detection of myocardial edema shows a sensitivity of 56 % in our infarct-like group and 69 % in the infarct-like myocarditis group reported by Lurz et al [16]. Röttgen et al [26] reached a sensitivity of 58 % for acute myocarditis and Gutberlet et al [8] achieved a sensitivity of 67 % for suspected chronic myocarditis ( • " Table 11). Although we analyzed the local edema only visually and not in a quantitative way, there was no relevant variance between our study and the literature.…”

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

“…A ressonância magnética (RM) tem sido considerada para o diagnóstico de miocardite aguda 273 . Consenso internacional de 2009 refere acurácia da RM de 56 a 78% para diagnóstico de miocardite aguda em comparação à biopsia endomiocárdica, sendo o melhor desempenho obtido quando da presença de dois de três parâmetros (realce precoce, edema e/ou realce tardio) 274 .…”

Significance of different non-invasive markers in diagnosis of latent myocarditis in comparison with biopsy data

“…However a comparison with morphological investigation is performed only for several from them (MRI) and controversial results have been obtained. Like this according to Sharite clinic data, sensitivity of delayed accumulation of contrast agent in myocardium is only 30.6% while specificity is 88.1% [14]. These values were 39.3% and 93.1% in case of combination of signs (delayed accumulation and «ede-ma» in T1-and T2-regimes) while other authors report insufficiently high specificity of MRI (54%) [12].…”

“…Авторами рекомендаций приводится пе-речень современных клинико-лабораторно-инструмен-тальных методов, которые следует использовать для вы-явления возможного миокардита, однако сопоставление с морфологическим исследованием проведено лишь для некоторых из них (в частности, МРТ) и дало противоре-чивые результаты. Так, по данным клиники Шарите, чув-ствительность отсроченного накопления контрастного препарата в миокарде составляет всего 30,6% при специ-фичности 88,1% [14], для комбинации признаков (отсро-ченное накопление и «отек» в режимах Т1 и Т2) эти пока-затели составляют 39,3 и 93,1%, в то время как другие ав-торы сообщают о недостаточно высокой специфичности МРТ (54%) [12]. Кроме того, метод информативнее при остром миокардите.…”