A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking

• Published in: Journal of cardiovascular magnetic resonance Vol. 19; no. 1; pp. 71 - 10
• Main Authors: Baeßler, Bettina, Treutlein, Melanie, Schaarschmidt, Frank, Stehning, Christian, Schnackenburg, Bernhard, Michels, Guido, Maintz, David, Bunck, Alexander C.
• Format: Journal Article
• Language: English
• Published: London Elsevier Inc 21.09.2017; BioMed Central; BioMed Central Ltd; Elsevier
• Subjects: Accuracy; Adult; Algorithms; Angiology; Area Under Curve; Biomechanical Phenomena; Biopsy; Cardiac magnetic resonance imaging; Cardiology; Cardiovascular disease; Care and treatment; Coronary vessels; Data acquisition; Datasets; Diagnosis; Diagnostic systems; Edema; Family medical history; Feature tracking; Female; Gadolinium; Heart; Humans; Image Interpretation, Computer-Assisted - methods; Imaging; Inflammation; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine - methods; Male; Mapping; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Myocardial Contraction; Myocardial inflammation; Myocarditis; Myocarditis - diagnostic imaging; Myocarditis - physiopathology; Pixels; Predictive Value of Tests; Radiology; Reproducibility of Results; Retrospective Studies; Review boards; ROC Curve; Sensitivity; Strain; Strain rate; T2-mapping; Tracking; Ventricular Function, Left; Ventricular Function, Right; Young Adult; Myocarditis; Myocardial inflammation; Feature tracking; T2-mapping; Cardiac magnetic resonance imaging; Strain; Strain rate
• ISSN: 1097-6647; 1532-429X; 1532-429X
• DOI: 10.1186/s12968-017-0387-x

The aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (CMR) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional Lake Louise criteria (LLC). CMR data from 67 patients with suspected acute myocarditis were retrospectively analyzed. Seventeen age- and gender-matched healthy subjects served as control. T2-mapping data were acquired using a Gradient-Spin-Echo T2-mapping sequence in short-axis orientation. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values and pixel-standard deviation (SD) were recorded. Afterwards, the parameters maxT2 (the highest segmental T2 value) and madSD (the mean absolute deviation (MAD) of the pixel-SDs) were calculated for each subject. Cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. A multiparametric imaging model containing madSD and LV global circumferential strain (GCSLV) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [AUC] 0.84) when compared to any model containing a single imaging parameter or to LLC (AUC 0.79). Adding late gadolinium enhancement (LGE) to the model resulted in a further increased diagnostic performance (AUC 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. A multiparametric CMR imaging model including the novel T2-mapping derived parameter madSD, the feature tracking derived strain parameter GCSLV and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC.