Author + information
- Received September 1, 2004
- Revision received November 3, 2004
- Accepted November 11, 2004
- Published online June 7, 2005.
- Hassan Abdel-Aty, MD⁎,
- Philipp Boyé, MD⁎,
- Anja Zagrosek, MD⁎,
- Ralf Wassmuth, MD⁎,
- Andreas Kumar, MD⁎,
- Daniel Messroghli, MD⁎,
- Petra Bock, MD⁎,
- Rainer Dietz, MD⁎,
- Matthias G. Friedrich, MD, FESC⁎,† and
- Jeanette Schulz-Menger, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Jeanette Schulz-Menger, Wiltbergstr. 50, D-13125, Berlin, Germany.
Objectives The aim of this research was to identify the diagnostic performance of gadolinium-enhanced and T2-weighted cardiovascular magnetic resonance (CMR) in suspected acute myocarditis.
Background Acute myocarditis is difficult to diagnose; CMR provides various means to visualize myocardial inflammatory changes. A CMR approach with clear-cut diagnostic criteria would be desirable.
Methods We investigated 25 patients with suspected acute myocarditis (18 males, 44 ± 17 years) and 23 healthy controls (13 males, 29 ± 10 years). Cardiovascular magnetic resonance studies included the following sequences: 1) T2-weighted triple inversion recovery; 2) T1-weighted spin echo before and over 4 min after gadolinium injection; and 3) inversion recovery-gradient echo 10 min after gadolinium injection. Qualitative and quantitative image analysis was performed for: 1) focal and global T2 signal intensity (SI); 2) myocardial global relative enhancement (gRE); and 3) areas of late gadolinium enhancement (LGE).
Results Both global T2 SI and gRE were higher in patients than in controls (T2: 2.3 ± 0.4 vs. 1.7 ± 0.4; p < 0.0001, gRE: 6.8 ± 4.0 vs. 3.7 ± 2.3; p < 0.001). The sensitivity, specificity, and diagnostic accuracy for T2 (cutoff value of 1.9) were 84%, 74%, and 79%, respectively; gRE: (cutoff value of 4.0) 80%, 68%, and 74.5% respectively; LGE: 44%, 100%, and 71%, respectively. The best diagnostic performance was obtained when “any-two” of the three sequences were positive in the same patient yielding a 76% sensitivity, 95.5% specificity, and 85% diagnostic accuracy.
Conclusions A combined CMR approach using T2-weighted imaging, early and late gadolinium enhancement, provides a high diagnostic accuracy and is a useful tool in the diagnosis and assessment of patients with suspected acute myocarditis.
- Received September 1, 2004.
- Revision received November 3, 2004.
- Accepted November 11, 2004.
- American College of Cardiology Foundation