CMR in myocarditis – what does mapping add?

Congress:

ECR 2020

Poster Number:

C-10207

Type:

Educational Exhibit

Keywords:

Cardiac, MR, Contrast agent-intravenous, Diagnostic procedure, Inflammation, Not applicable

Authors:

I. Hutuca¹, A. V. Marinescu², A. Nicula¹, R. T. Ciltea³, A. N. Marinescu¹, G. Iana¹; ¹Bucharest/RO, ²Bucuresti, România/RO, ³Bucuresti/RO

DOI:

10.26044/ecr2020/C-10207

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10207

Fig. 1: Patterns of myocardial LGE

Table 1: 2009 Lake Louise Criteria of diagnosis

Table 2: Updated diagnosis criteria

Fig. 2: High signal intensity on T2-weighted image - suggestive for edema (left) and...

Learning objectives

·To present the current diagnostic criteria using Cardiac Magnetic Resonance (CMR) ·To highlight the use of CMR in the patient prognosis ·To underline the role of CMR indifferentiating myocarditis from the other etiologies of Myocardial infarction with nonobstructive coronary arteries (MINOCA)

Background

Acute myocarditis is defined as myocardial inflammation and it can be caused by viral and bacterial infections, toxic causes, systemic diseases, immune reactions or mechanical injuries. Because of its heterogeneous clinical presentation , myocardial inflammation is commonly underdiagnosed in clinical practice. Myocarditis is an important cause of sudden death in young adults, accounting for up to 20% of sudden cardiac deaths1. Furthermore, it can lead to the development of dilated cardiomyopathy. The patients can present with a broad spectrum of symptoms that include chest pain,...

Findings and procedure details

Diagnostic targets CMR sequences can detect changes in the tissue related to inflammation. There are three main CMR diagnostic targets for the myocarditis diagnostic: Myocardial edema. Edema causes prolongation of both T1 and T2 relaxation times. Edema can be assessed as T2-weighted images signal hyperintensity or T2 mapping by measuring the water-induced prolongation of T2 relaxation time. T2 is preferred because T1 increase can also be seen in fibrosis. Hyperemia and capillary leak. Hyperemia, increased vascular permeability and extracellular space expansion can be targeted with...

Conclusion

CMR is proven to be a powerful non-invasive method of tissue characterization in myocardial inflammation. Mapping sequences have increased the sensitivity and specificity of the diagnosis, and the new CMR diagnostic criteria should be used in practice. No single sequence has the best sensitivity and specificity, and a combination of the sequences is advisable. CMR is becoming a plurivalent tool that can be used not only for diagnosis, but also in prognosis and in differentiating the subtle changes from other cardiac diseases with the same...

Personal information and conflict of interest

I. Hutuca; Bucharest/RO - nothing to disclose A. V. V. Marinescu; Bucharest, ROMÂNIA/RO - nothing to disclose A. N. Marinescu; Bucharest/RO - nothing to disclose A. Nicula; Bucharest/RO - nothing to disclose R. T. Ciltea; Bucharest/RO - nothing to disclose G. Iana; Bucharest/RO - nothing to disclose

References

1. 1. Cooper LT. Myocarditis. N Engl J Med. 2009. doi:10.1056/NEJMra0800028 2. 2. HAUCK AJ, KEARNEY DL, EDWARDS WD. Evaluation of Postmortem Endomyocardial Biopsy Specimens From 38 Patients With Lymphocytic Myocarditis: Implications for Role of Sampling Error. Mayo Clin Proc. 1989. doi:10.1016/S0025-6196(12)61286-5 3. 3. Kotanidis CP, Bazmpani MA, Haidich AB, Karvounis C, Antoniades C, Karamitsos TD. Diagnostic Accuracy of Cardiovascular Magnetic Resonance in Acute Myocarditis: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. 2018. doi:10.1016/j.jcmg.2017.12.008 4. 4. Ferreira VM, Schulz-Menger J, Holmvang G, et al....