Usefulness of Subepicardial Hyperemia on Contrast-Enhanced First-Pass Magnetic Resonance Perfusion Imaging for Diagnosis of Acute Myocarditis

Zarka, Samuel; Bouleti, Claire; Arangalage, Dimitri; Chopra, Houzefa; Chillon, Sylvie; Henry–Feugeas, Marie-Cécile; Abtan, Jérémie; Juliard, Jean‐Michel; Iung, Bernard; Vahanian, Alec; Laissy, Jean-Pierre; Ou, Phalla

doi:10.1016/j.amjcard.2016.05.022

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…However, the main problem is to differentiate cellularity vs edema and perfusion abnormalities with a single b-value of 300 sec/ mm 2 . Focal inflammation, cell necrosis and tissue edema are indeed all implicated as being responsible for excessive subepicardial delayed enhancement seen mainly in the acute phase of myocarditis [12,[19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Feasibility of cardiac diffusion-weighted MR imaging in acute myocarditis: a pilot study

Jp¹,

Gaxotte²,

Ou³

et al. 2018

Blood Heart Circ

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Purpose: To prospectively determine whether diffusion-weighted cardiac MR imaging (DWI) is feasible and to determine cardiac DWI patterns in patients with acute myocarditis, by comparison with delayed-enhancement (DE) cardiac magnetic resonance (CMR) sequences.Method: Fifty-eight consecutive patients referred for CMR with a clinical presentation suggestive of acute myocarditis were included. Rest MR examinations included DWI, black-blood fat-suppressed T2-weighted, first-pass perfusion, and DE sequences. Abnormal DWI areas were matched to abnormal DE areas. The apparent diffusion coefficient (ADC) was measured in involved areas and compared to remote normal areas.Result: Qualitative assessment of DWI compared with DE images yielded a sensitivity of 92%. DWI patterns were significantly correlated to DE patterns, with focal or multifocal nonsegmental nonsubendocardial hypersignals (DWI, 2.78 ± 0.62 segments vs DE, 3.36 ± 0.63 segments, p = ns), predominantly in an inferolateral location. Qualitative assessment of DWI compared to LGE images yielded a sensitivity of 97% and a specificity of 61%. Segment-by-segment comparison showed a high level of correlation (y = (0.91) x + 0.47, r = 0.9049). The ADC of affected segments vs normal remote myocardium was 74.1 % ± 5.6 %. The absolute ADCs (abnormal DE area 0.00751±0.00042 mm2/s, normal myocardium close to abnormal DE area 0.00824±0.0004 mm2/s, and remote normal myocardium 0.00928±0.00049 mm2/s) and relative ADCs were significantly different between groups (P<0.05) except between abnormal DE area and normal myocardium close to abnormal DE area. Conclusion:Extent of myocardial involvement in myocarditis is larger, using absolute ADC measurements at DWI imaging, than expected at DE enhancement. Moreover, ADC maps should help better understand inflammatory phenomena such as an underestimated extent of lesions by late-enhancement sequences. Hence, this sequence should help better appreciate the real extent of myocardial injury in myocarditis.

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Section: Discussionmentioning

confidence: 99%

Feasibility of cardiac diffusion-weighted MR imaging in acute myocarditis: a pilot study

Jp¹,

Gaxotte²,

Ou³

et al. 2018

Blood Heart Circ

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“…These changes include dilatation of the myocardial vascular bed with hyperemia, presence of intracellular and interstitial edema, myocyte necrosis, accumulation of debris in the extracellular space, and collagen deposition resulting in fibrosis and scar formation 61 . CMR plays a pivotal role in assessing edema through T2 mapping and hyperemia through early gadolinium enhancement, which helps in the evaluation of hyperemia during myocardial inflammation 61,64 . Another significant CMR finding with diagnostic relevance in myocarditis is the presence of LGE, indicating severe inflammation, myocyte injury, necrosis, fibrosis, and ultimately scarring 61 (Figure 4).…”

Section: Myocarditismentioning

confidence: 99%

Advanced cardiac imaging in preventing sudden cardiac death in athletes

Locatelli,

Lis,

Monti

et al. 2024

JMEXFRI

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Competitive athletes are known to undergo physiological adaptations to meet the demands of rigorous training which can mimic pathological conditions, leading to an overlap between normal physiological changes and potentially life-threatening cardiac abnormalities. Sudden cardiac death (SCD) in athletes is a rare but devastating event, underscoring the need for early detection of cardiac abnormalities to prevent such tragedies. This review highlights the pivotal role of advanced cardiac imaging techniques, specifically cardiac magnetic resonance imaging (CMR) and coronary computed tomography angiography (CCTA), in the prevention of SCD in competitive athletes. CMR and CCTA offer non-invasive, comprehensive assessments of cardiac morphology and function, providing valuable insights into the athlete's heart. Various physiological adaptations observed in athletes' hearts will be presented, including left ventricular hypertrophy and right ventricular dilation, which can be mistaken for pathological conditions. The "grey zone" concept underscores the importance of advanced imaging in distinguishing between normal and potentially abnormal cardiac changes. For specific pathological conditions linked to SCD in athletes, CMR aids in accurate diagnosis by differentiating tissue characteristics and assessing late gadolinium enhancement (LGE) patterns. Additionally, CMR plays a critical role in identifying coronary artery anomalies, myocarditis, and coronary artery disease in athletes over 35 years old, enabling early intervention and treatment. The new Padua criteria will also be discussed, which incorporate tissue characterization and novel ECG criteria to diagnose arrhythmogenic cardiomyopathy more accurately. Collaborative efforts between sports medicine specialists, cardiologists, and radiologists are essential in establishing standardized protocols for responsible imaging use, ultimately enhancing the safety and well-being of competitive athletes.

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“…The Lake Louise Criteria are based on the detection of two of three characteristic features: myocardial edema at T2-weighted MRI, hyperemia at early T1-weighted contrast-enhanced MRI, and fibrosis during LGE, usually with a nonischemic (ie, midwall or subepicardial) pattern that does not follow a coronary artery distribution (Table 10, Fig 15) (18). EGE and first-pass perfusion can be useful for the identification of hyperemia (10,74). LGE does not always imply the presence of fibrosis or necrosis, because increased interstitial space due to diffuse inflammation can produce areas of LGE (13).…”

Section: Myocarditismentioning

confidence: 99%

Cardiac MRI in Patients with Acute Chest Pain

Broncano

Bhalla

Caro³

et al. 2021

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Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-STsegment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients.

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Usefulness of Subepicardial Hyperemia on Contrast-Enhanced First-Pass Magnetic Resonance Perfusion Imaging for Diagnosis of Acute Myocarditis

Cited by 10 publications

References 20 publications

Feasibility of cardiac diffusion-weighted MR imaging in acute myocarditis: a pilot study

Feasibility of cardiac diffusion-weighted MR imaging in acute myocarditis: a pilot study

Advanced cardiac imaging in preventing sudden cardiac death in athletes

Cardiac MRI in Patients with Acute Chest Pain

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