Utility of cardiac MRI for diagnosis and post-treatment follow-up of lupus myocarditis

Abstract

Clinical myocardial involvement in systemic lupus erythematosus is rare. Lupus myocarditis is usually not detected until significant decrease in myocardial function becomes clinically evident. This case report describes MR imaging of lupus myocarditis that was used for diagnosis and follow up in a patient who declined cardiac biopsy. We also review the literature related to myocardial imaging by MRI.

Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy

“…Interest is growing in quantifying the burden of myocarditis in SLE to guide treatment response (66). Initial approaches utilized T2-W and pre- and post- contrast T1-W images to calculate a T2-ratio as a marker of increased myocardial edema and early global relative contrast enhancement ratio as a marker of increased capillary leak indicative of myocardial inflammation (67).…”

Cardiogenic Shock as the Initial Presentation of Systemic Lupus Erythematosus: A Case Report and Review of the Literature

“…EMB may be associated with life‐threatening complications including right ventricular perforation and tamponade with an overall rate of 6%; therefore, its use may be limited to patients who do not respond to therapy based on clinical diagnosis or in whom biopsy results could significantly alter the therapeutic approach. 24 The role of cardiac magnetic resonance imaging in providing a definitive diagnosis in this clinical setting has recently been recognized 35–37 . Recent studies have demonstrated that this modality may become the primary tool for noninvasive assessment and confirmation of suspected lupus myocarditis 35,36 Table II.…”

“…24 The role of cardiac magnetic resonance imaging in providing a definitive diagnosis in this clinical setting has recently been recognized. [35][36][37] Recent studies have demonstrated that this modality may become the primary tool for noninvasive assessment and confirmation of suspected lupus myocarditis. 35,36 Table II summarizes published reports and case series of lupus myocarditis with diagnostic modalities, therapy, and outcomes.…”

“…[35][36][37] Recent studies have demonstrated that this modality may become the primary tool for noninvasive assessment and confirmation of suspected lupus myocarditis. 35,36 Table II summarizes published reports and case series of lupus myocarditis with diagnostic modalities, therapy, and outcomes. In the present case, patient's age, clinical presentation, and extensive workup ruled out coronary artery disease, including coronary anomalies, valvular heart disease, pregnancy, thyrotoxicosis, hemochromatosis, hypertension, stress, and infection as possible etiologies for her dilated cardiomyopathy.…”

Cardiovascular Involvement in Systemic Lupus Erythematosus

“…(Busteed et al, 2004) Other investigations that may help to diagnose myocarditis include a gallium scan18 and magnetic resonance imaging (MRI). (Saremi et al, 2007) Nuclear medicine scans rely on labeling of anti myosin antibodies with radiopharmaceuticals, and may not be available in all clinical settings. Different MRI techniques may support the diagnosis of myocarditis.…”