Myocarditis MRI: Difference between revisions
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==Overview== | ==Overview== | ||
[[Cardiac MRI]] findings associated with [[myocarditis]] include [[myocardial inflammation]], [[myocardial edema]], [[capillary leak]], and [[reduced left ventricular function]]. While the cardiac MRI pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the subendocardium. | [[Cardiac MRI]] findings associated with [[myocarditis]] include [[myocardial inflammation]], [[myocardial edema]], [[capillary leak]], and [[reduced left ventricular function]]. While the cardiac MRI pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the subendocardium. | ||
==Findings on MRI== | ==Findings on MRI== | ||
*Cardiac MRI may be helpful in the diagnosis of myocarditis. Findings on MRI suggestive of myocarditis include:<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref><ref>{{cite journal |author=Skouri HN, Dec GW, Friedrich MG, Cooper LT |title=Noninvasive imaging in myocarditis |journal=J. Am. Coll. Cardiol. |volume=48 |issue=10 |pages=2085-93 |year=2006 |pmid=17112998 |doi=10.1016/j.jacc.2006.08.017}}</ref><ref name="pmid21106555">{{cite journal| author=Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A et al.| title=Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis. | journal=Heart | year= 2011 | volume= 97 | issue= 16 | pages= 1312-8 | pmid=21106555 | doi=10.1136/hrt.2010.204818 | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106555 }} </ref><ref name="pmid19898290">{{cite journal| author=Al-Mallah M, Kwong RY| title=Clinical application of cardiac CMR. | journal=Rev Cardiovasc Med | year= 2009 | volume= 10 | issue= 3 | pages= 134-41 | pmid=19898290 | doi= | pmc= | url= }} </ref><ref name="pmid19389557">{{cite journal| author=Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT et al.| title=Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. | journal=J Am Coll Cardiol | year= 2009 | volume= 53 | issue= 17 | pages= 1475-87 | pmid=19389557 | doi=10.1016/j.jacc.2009.02.007 | pmc=PMC2743893 | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19389557 }}</ref> | *Cardiac MRI may be helpful in the diagnosis of myocarditis. Findings on MRI suggestive of myocarditis include:<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref><ref>{{cite journal |author=Skouri HN, Dec GW, Friedrich MG, Cooper LT |title=Noninvasive imaging in myocarditis |journal=J. Am. Coll. Cardiol. |volume=48 |issue=10 |pages=2085-93 |year=2006 |pmid=17112998 |doi=10.1016/j.jacc.2006.08.017}}</ref><ref name="pmid21106555">{{cite journal| author=Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A et al.| title=Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis. | journal=Heart | year= 2011 | volume= 97 | issue= 16 | pages= 1312-8 | pmid=21106555 | doi=10.1136/hrt.2010.204818 | pmc= | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21106555 }} </ref><ref name="pmid19898290">{{cite journal| author=Al-Mallah M, Kwong RY| title=Clinical application of cardiac CMR. | journal=Rev Cardiovasc Med | year= 2009 | volume= 10 | issue= 3 | pages= 134-41 | pmid=19898290 | doi= | pmc= | url= }} </ref><ref name="pmid19389557">{{cite journal| author=Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT et al.| title=Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. | journal=J Am Coll Cardiol | year= 2009 | volume= 53 | issue= 17 | pages= 1475-87 | pmid=19389557 | doi=10.1016/j.jacc.2009.02.007 | pmc=PMC2743893 | http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19389557 }}</ref><ref>{{cite journal |author=Skouri HN, Dec GW, Friedrich MG, Cooper LT |title=Noninvasive imaging in myocarditis |journal=J. Am. Coll. Cardiol. |volume=48 |issue=10 |pages=2085-93 |year=2006 |pmid=17112998 |doi=10.1016/j.jacc.2006.08.017}}</ref> | ||
**'''Myocardial inflammation''': Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed [[gadolinium]] hyperenhancement on [[cardiac MRI]] (cMRI). While the cMRI pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the subendocardium. The areas of hyperenhancement are often observed in the lateral and inferior territories of the heart. When used in conjunction with the findings on coronary angiography, cardiac MRI is useful in distinguishing between a diagnosis of myocarditis and myonecrosis associated with myocardial ischemia. Among 79 patients with elevated cardiac biomarkers who were suspected of having [[ACS]] and had normal [[coronary arteries]] on [[coronary angiography]], 81% of the patients (including those with preserved [[ejection fraction]]) were diagnosed with [[myocarditis]] based on cMRI findings. | **'''Myocardial inflammation''': Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed [[gadolinium]] hyperenhancement on [[cardiac MRI]] (cMRI). While the cMRI pattern of [[gadolinium]] hyperenhancement in [[ST segment elevation myocardial infarction]] is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in [[myocarditis]] in contrast involves the [[epicardium]] and spares the subendocardium. The areas of hyperenhancement are often observed in the lateral and inferior territories of the heart. When used in conjunction with the findings on coronary angiography, cardiac MRI is useful in distinguishing between a diagnosis of myocarditis and myonecrosis associated with myocardial ischemia. Among 79 patients with elevated cardiac biomarkers who were suspected of having [[ACS]] and had normal [[coronary arteries]] on [[coronary angiography]], 81% of the patients (including those with preserved [[ejection fraction]]) were diagnosed with [[myocarditis]] based on cMRI findings. | ||
**'''Myocardial edema''': High T2 signal intensity areas suggests [[myocardial edema]]. | **'''Myocardial edema''': High T2 signal intensity areas suggests [[myocardial edema]]. | ||
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==Sensitivity and Specificity== | ==Sensitivity and Specificity== | ||
CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used.<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref> | CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used.<ref name="pmid15936612">{{cite journal| author=Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D et al.| title=Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. | journal=J Am Coll Cardiol | year= 2005 | volume= 45 | issue= 11 | pages= 1815-22 | pmid=15936612 | doi=10.1016/j.jacc.2004.11.069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15936612 }} </ref><ref name="pmid14993139">{{cite journal| author=Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H et al.| title=Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. | journal=Circulation | year= 2004 | volume= 109 | issue= 10 | pages= 1250-8 | pmid=14993139 | doi=10.1161/01.CIR.0000118493.13323.81 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14993139 }} </ref> | ||
*Focal and global T2 signal intensity | *Focal and global T2 signal intensity | ||
*Myocardial global relative enhancement | *Myocardial global relative enhancement | ||
*Delayed gadolinium enhancement | *Delayed gadolinium enhancement | ||
Among 21 patients who underwent biopsy of contrast enhanced regions in a series in Germany, histopathologic findings in 19 patients were consistent with [[myocarditis]]. | Among 21 patients who underwent biopsy of contrast enhanced regions in a series in Germany, histopathologic findings in 19 patients were consistent with [[myocarditis]]. | ||
==ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: Indications to Perform Cardiac MRI in the Patient with Suspected Myocarditis<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157 }} </ref> (DO NOT EDIT)== | ==ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: Indications to Perform Cardiac MRI in the Patient with Suspected Myocarditis<ref name="pmid20479157">{{cite journal| author=American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al.| title=ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. | journal=Circulation | year= 2010 | volume= 121 | issue= 22 | pages= 2462-508 | pmid=20479157 | doi=10.1161/CIR.0b013e3181d44a8f | pmc=PMC3034132 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20479157 }} </ref> (DO NOT EDIT)== | ||
Revision as of 13:34, 21 January 2020
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Myocarditis Microchapters |
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Case Studies |
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Myocarditis MRI On the Web |
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American Roentgen Ray Society Images of Myocarditis MRI |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. Homa Najafi, M.D.[2]
Overview
Cardiac MRI findings associated with myocarditis include myocardial inflammation, myocardial edema, capillary leak, and reduced left ventricular function. While the cardiac MRI pattern of gadolinium hyperenhancement in ST segment elevation myocardial infarction is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in myocarditis in contrast involves the epicardium and spares the subendocardium.
Findings on MRI
- Cardiac MRI may be helpful in the diagnosis of myocarditis. Findings on MRI suggestive of myocarditis include:[1][2][3][4][5][6]
- Myocardial inflammation: Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed gadolinium hyperenhancement on cardiac MRI (cMRI). While the cMRI pattern of gadolinium hyperenhancement in ST segment elevation myocardial infarction is transmural and extends from the endocardium to the epicardium, the patchy, non-segmental hyperenhancement pattern in myocarditis in contrast involves the epicardium and spares the subendocardium. The areas of hyperenhancement are often observed in the lateral and inferior territories of the heart. When used in conjunction with the findings on coronary angiography, cardiac MRI is useful in distinguishing between a diagnosis of myocarditis and myonecrosis associated with myocardial ischemia. Among 79 patients with elevated cardiac biomarkers who were suspected of having ACS and had normal coronary arteries on coronary angiography, 81% of the patients (including those with preserved ejection fraction) were diagnosed with myocarditis based on cMRI findings.
- Myocardial edema: High T2 signal intensity areas suggests myocardial edema.
- Myocardial scar: Gadolinium-enhanced magnetic resonance imaging (MRI) may also aid in assessing the extent of myocardial scarring (areas of delayed gadolinium enhancement) which is largely confined to the epicardium.
- Myocardial capillary leak: Myocardial early gadolinium enhancement ratio (ratio between myocardium and skeletal muscle) ≥ 4.0 is suggestive of hyperemia and capillary leakage.
- Myocardial dysfunction: Cardiac MRI can be used to assess for the presence of and severity of myocardial dysfunction associated with myocarditis.
- Associated pericardial effusion: Cardiac MRI can be used to assess for the presence of and severity of a pericardial effusion associated with myocarditis. The association of a pericardial effusion along with myocarditis is referred to as myopericarditis.
Sensitivity and Specificity
CMR was reported to have a sensitivity of 76%, specificity of 95.5%, and overall diagnostic accuracy of 85% when any-two of the following three sequences were used.[1][7]
- Focal and global T2 signal intensity
- Myocardial global relative enhancement
- Delayed gadolinium enhancement
Among 21 patients who underwent biopsy of contrast enhanced regions in a series in Germany, histopathologic findings in 19 patients were consistent with myocarditis.
ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: Indications to Perform Cardiac MRI in the Patient with Suspected Myocarditis[8] (DO NOT EDIT)
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CMR may be used for assessment of patients with LV dysfunction or hypertrophy or suspected forms of cardiac injury not related to ischemic heart disease. When the diagnosis is unclear, CMR may be considered to identify the etiology of cardiac dysfunction in patients presenting with heart failure, including
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Performance of cardiac MRI is generally indicated in those patients with new or persisting symptoms of chest pain and congestive heart failure, who have evidence of significant myocardial injury, in the absence of or in whom there is a low suspicion of coronary atherosclerosis.[5]
Overview
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include:
- [Finding 1]
- [Finding 2]
- [Finding 3]
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include:
- [Complication 1]
- [Complication 2]
- [Complication 3]
References
- ↑ 1.0 1.1 Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D; et al. (2005). "Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches". J Am Coll Cardiol. 45 (11): 1815–22. doi:10.1016/j.jacc.2004.11.069. PMID 15936612. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Skouri HN, Dec GW, Friedrich MG, Cooper LT (2006). "Noninvasive imaging in myocarditis". J. Am. Coll. Cardiol. 48 (10): 2085–93. doi:10.1016/j.jacc.2006.08.017. PMID 17112998.
- ↑ Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A; et al. (2011). "Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis". Heart. 97 (16): 1312–8. doi:10.1136/hrt.2010.204818. PMID 21106555. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Al-Mallah M, Kwong RY (2009). "Clinical application of cardiac CMR". Rev Cardiovasc Med. 10 (3): 134–41. PMID 19898290.
- ↑ 5.0 5.1 Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT; et al. (2009). "Cardiovascular magnetic resonance in myocarditis: A JACC White Paper". J Am Coll Cardiol. 53 (17): 1475–87. doi:10.1016/j.jacc.2009.02.007. PMC 2743893. PMID 19389557. Unknown parameter
|http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=ignored (help) - ↑ Skouri HN, Dec GW, Friedrich MG, Cooper LT (2006). "Noninvasive imaging in myocarditis". J. Am. Coll. Cardiol. 48 (10): 2085–93. doi:10.1016/j.jacc.2006.08.017. PMID 17112998.
- ↑ Mahrholdt H, Goedecke C, Wagner A, Meinhardt G, Athanasiadis A, Vogelsberg H; et al. (2004). "Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology". Circulation. 109 (10): 1250–8. doi:10.1161/01.CIR.0000118493.13323.81. PMID 14993139.
- ↑ American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA; et al. (2010). "ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2462–508. doi:10.1161/CIR.0b013e3181d44a8f. PMC 3034132. PMID 20479157.