Texture analysis of cardiac MRI T1 and T2 maps combined with mean T2 time or T1 features yielded an AUC of 0.76 (95% CI 0.43-0.95) for acute and 0.85 (95% CI 0.57-0.90) for chronic myocarditis.
Observational (n=71)
Does texture analysis of cardiac MRI T1 and T2 maps improve the diagnostic performance for heart failure-like myocarditis compared to standard mapping or Lake Louise criteria?
Texture analysis of cardiac MRI T1 and T2 maps provides quantitative parameters that may improve the diagnostic accuracy for acute and chronic heart failure-like myocarditis compared to standard criteria.
Effect estimate: AUC 0.76 (acute), AUC 0.85 (chronic) (95% CI 0.43-0.95 (acute), 0.57-0.90 (chronic))
Background The establishment of a timely and correct diagnosis in heart failure–like myocarditis remains one of the most challenging in clinical cardiology. Purpose To assess the diagnostic potential of texture analysis in heart failure–like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard. Materials and Methods Seventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial (ClinicalTrials. gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1. 5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 and T2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation. Results In participants with acute heart failure–like myocarditis (n = 31; mean age, 47 years ± 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2GLNU) showed diagnostic performance similar to that of mean myocardial T2 time (AUC, 0. 69 for both). The combination of mean T2 time and T2GLNU had the highest AUC (0. 76; 95% confidence interval CI: 0. 43, 0. 95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure–like myocarditis (n = 40; mean age, 48 years ± 13; 12 women), the histogram feature T2ₖurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0. 81; 95% CI: 0. 66, 0. 96). The combination of the two texture features, T2ₖurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0. 85; 95% CI: 0. 57, 0. 90; sensitivity, 90% 36 of 40; and specificity, 72% 29 of 40). Conclusion In this proof-of-concept study, texture analysis applied on cardiac MRI T1 and T2 mapping delivers quantitative imaging parameters for the diagnosis of acute or chronic heart failure–like myocarditis and might be superior to Lake Louise criteria or averaged myocardial T1 or T2 values. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by de Roos in this issue.
Baeßler et al. (Tue,) conducted a observational in Heart failure-like myocarditis (n=71). Texture analysis of cardiac MRI T1 and T2 maps vs. Endomyocardial biopsy and standard Lake Louise criteria was evaluated on Diagnostic performance (AUC) for myocarditis (AUC 0.76 (acute), AUC 0.85 (chronic), 95% CI 0.43-0.95 (acute), 0.57-0.90 (chronic)). Texture analysis of cardiac MRI T1 and T2 maps combined with mean T2 time or T1 features yielded an AUC of 0.76 (95% CI 0.43-0.95) for acute and 0.85 (95% CI 0.57-0.90) for chronic myocarditis.
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