Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis

Figures

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  Figure 1. CMR Parameter ROC Curves for Discrimination of Subacute Myocarditis from Healthy Controls and Acute Myocarditis. (A) ROC curves demonstrate excellent areas under the curve (AUCs) for all four tissue characterization parameters for discrimination of acute myocarditis from healthy controls. (B) In the discrimination of subacute myocarditis from healthy controls, LGE and ECV performed best with AUCs of 0.96 (p < 0.0001) and 0.90 (p < 0.0001) respectively; 0.79 (p < 0.001) for T2 with a criterion of >49 ms; 0.76 (p = 0.002) for T1 with a criterion of >1015 ms. (C) For comparison of acute from subacute myocarditis, the areas under the curve (AUCs) were 0.76 (p < 0.001) for LGE with a criterion of >2, 8% of LV myocardial mass; 0.66 (p = 0.049) for T2 with a criterion of >51 ms; T1 and ECV showed no significant differences. The diagonal line course indicates difficult discrimination of acute vs. subacute myocarditis by CMR alone.

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  Figure 2. Diagnostic Performance of CMR Criteria Combination for Discrimination of Subacute Myocarditis from Healthy Controls. The best diagnostic performance in the detection of subacute myocarditis and the discrimination from healthy controls was achieved by both ECV evaluation alone or in combination with T1 mapping, demonstrating a sensitivity of 96% (CI 78–100) and an accuracy of 91% (CI 77–98). A segmental or global increase of native T1 > 1015 ms and ECV > 28% was applied, derived from ROC analysis. LLC = Lake Louise criteria.

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  Figure 3. Location of LGE and Elevated Mapping Parameters per AHA Segments. Heatmapped 17-segment-model schemes (according to the American Heart Association) illustrate the percentage frequency of the occurrence of (A) LGE, (B) elevated T1, (C) elevated extracellular volume fraction (ECV) and (D) elevated T2.

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  Figure 4. Appearance of Acute and Subacute Myocarditis in CMR. (A) Acute myocarditis often demonstrates more obvious alterations of tissue characterization parameters including high prevalence and extent of late gadolinium enhancement (LGE) and elevated T2. (B) Subacute myocarditis can manifest with marked occurrence of LGE and elevated T1, ECV and T2; but in many cases may demonstrate rather subtle changes in tissue characterization.