Myocarditis MRI
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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: Cafer Zorkun, M.D., Ph.D. [2], Varun Kumar, M.B.B.S.
Overview
Myocardial inflammation associated with myocarditis appears as a high intensity signal with delayed gadolinium hyperenhancement on cardiac MRI (cMRI). [1]. 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[2].
Cardiac Magnetic Resonance Imaging
Cardiac magnetic resonance imaging (cMRI or CMR) in conjunction iwth other imaging studies is useful in diagnosing myocarditis by visualizing patchy, non-segmental inflammation by gadolinium hyperenhancement that is confined to the epicardial layer of the myocardium.[3]. In a recent study involving 79 patients suspected of having ACS, 81% of the patients (including those with preserved ejection fraction) were diagnosed with myocarditis based on CMR findings[4].
Gadolinium-enhanced magnetic resonance imaging (MRI) aid in assessing the extent of myocardial edema and inflammation. Extent of myocardial scarring has also been assessed with delayed enhanced MRI[5].
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].
- Focal and global T2 signal intensity
- Myocardial global relative enhancement
- Delayed gadolinium enhancement
On CMR, inflammatory regions of cardia in myocarditis appear as contrast-enhanced regions. These are often observed on lateral and inferior walls and can be used to guide biopsy. Among 21 patients who underwent biopsy of contrast enhanced regions in a series in Germany, histopathologic findings in 19 patients were consistent with myocarditis[6].
CMR in myocarditis is generally indicated in patients with new or persisting symptoms, evidence for significant myocardial injury, and suspected viral etiology[7].
CMR findings in Myocarditis[7]:
- High T2 signal intensity areas suggests edema.
- Myocardial early gadolinium enhancement ratio (ratio between myocardium and skeletal muscle) ≥4.0 is suggestive of hyperemia and capillary leakage.
- Areas of delayed gadolinium enhancement suggesting myocardial injury or inflammation.
- Systolic dysfunction and pericardial effusion may also be noted on CMR
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.
- ↑ 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.
- ↑ 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.
- ↑ Al-Mallah M, Kwong RY (2009). "Clinical application of cardiac CMR". Rev Cardiovasc Med. 10 (3): 134–41. PMID 19898290.
- ↑ 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.
- ↑ 7.0 7.1 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.