What is the clinical evidence from this study?

Study design: Observational. Population: Suspected myocarditis (n=129). Intervention: Comprehensive cardiac magnetic resonance (CMR) mapping vs. Endomyocardial biopsy (EMB) and standard Lake Louise criteria. Primary outcome: Diagnostic performance (area under the curve) for myocarditis (AUC 0.82).

June 12, 2026

Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis

Key Result

Comprehensive cardiac magnetic resonance mapping, specifically native T1, yielded the best diagnostic performance for acute suspected myocarditis (AUC 0.82) compared to standard criteria (AUC 0.56).

Key Points

This study aims to evaluate the diagnostic performance of comprehensive cardiac magnetic resonance imaging versus endomyocardial biopsy in suspected myocarditis.
Patients underwent cardiac catheterization, biventricular endomyocardial biopsy, and CMR imaging on 1.5-T and 3-T scanners.
The CMR protocol included T1 and T2 mapping, and assessment using Lake Louise criteria for myocarditis.
Patients were categorized based on symptom duration: acute (≤14 days) and chronic (>14 days).
In patients with acute symptoms, native T1 mapping showed the best diagnostic performance with an AUC of 0.82.
For chronic symptoms, T2 mapping was the only technique with an acceptable AUC of 0.77.
Diagnostic performances of 1.5-T and 3.0-T imaging did not significantly differ.

Study Design

Type

Observational (n=129)

Structured PICO

Does comprehensive CMR imaging (T1 and T2 mapping) provide accurate diagnostic performance compared to endomyocardial biopsy in patients with suspected myocarditis?

Population

129 consecutive patients with suspected myocarditis who underwent endomyocardial biopsy, cardiac catheterization, and CMR imaging.

Exposure

Comprehensive cardiac magnetic resonance (CMR) imaging including native T1 mapping, T2 mapping, extracellular volume fraction (ECV), and standard Lake Louise criteria (LLC) on 1.5-T and 3.0-T scanners.

Comparator

Endomyocardial biopsy (EMB) as the reference standard.

Outcome

Diagnostic performance defined by the area under the curve (AUC) of receiver-operating curves.surrogate

CMR mapping techniques (native T1 and T2) are superior to standard Lake Louise criteria for diagnosing acute myocarditis, whereas only T2 mapping provides acceptable diagnostic performance in chronic cases.

Main Result

Effect estimate: AUC 0.82

Abstract

BACKGROUND: Data suggest that T1 and T2 mapping have excellent diagnostic accuracy in patients with suspected myocarditis. However, the true diagnostic performance of comprehensive cardiac magnetic resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been determined. OBJECTIVES: This study assessed the performance of CMR imaging, including T1 and T2 mapping, compared with EMB in an unselected, consecutive patient cohort with suspected myocarditis. It also examined the potential role of CMR field strength by comparing 1.5-T versus 3.0-T imaging. METHODS: Patients underwent biventricular EMB, cardiac catheterization (for exclusion of coronary artery disease), and CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis as well as native T1, calculation of extracellular volume fraction (ECV), and T2 mapping (only on 1.5-T). Patients were divided into 2 groups according to symptom duration (acute: ≤14 days vs. chronic: >14 days). RESULTS: A total of 129 patients underwent 1.5-T imaging. In patients with acute symptoms, native T1 yielded the best diagnostic performance as defined by the area under the curve (AUC) of receiver-operating curves (0.82) followed by T2 (0.81), ECV (0.75), and LLC (0.56). In patients with chronic symptoms, only T2 mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of native T1, ECV, and LLC were comparable to 1.5-T with no significant differences. CONCLUSIONS: In patients with acute symptoms, mapping techniques provide a useful tool for confirming or rejecting the diagnosis of myocarditis and are superior to the LLC. However, only T2 mapping has acceptable diagnostic performance in patients with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis MyoRacer; NCT02177630).

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