Multiparametric cardiac magnetic resonance imaging in pediatric and adolescent patients with acute myocarditis

Figures

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  Fig. 1. Graphs with individual plotted values show the distribution of myocardial magnetic resonance parameters in controls and in the subgroup of patients with myocarditis and available mapping parameters (26/43 patients and 16/16 controls). a T1 relaxation time. b T2 relaxation time. c Extracellular volume fraction. d T2 signal intensity ratio. T2 signal intensity ratio was available in all patients and controls. Individual values are represented as single dots. The horizontal lines show the mean values with error bars representing one standard deviation. P-values were obtained using an unpaired Student’s t-test

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  Fig. 2. Graphs show receiver operating characteristic (ROC) curves for the subgroup cohort of patients (26/43) and control patients (16/16) with available mapping parameters. a The individual performance of different cardiac magnetic resonance parameters are presented: native T1 relaxation time (area under the curve [AUC]: 0.873), T2 relaxation time (AUC: 0.899), extracellular volume (AUC: 0.687), T2 signal intensity ratio (AUC: 0.868) and late gadolinium enhancement (AUC: 0.919). b The performance of combined scores is visualized: 2018 Lake Louise criteria (AUC: 0.944), 2018 Lake Louise criteria excluding mapping parameters (AUC: 0.870), and a non-contrast score of native T1 and T2 relaxation times only (AUC: 0.920)

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  Fig. 3. Line graphs show the chronological course of T1 relaxation time (a), T2 relaxation time (b), extracellular volume fraction (c) and T2 signal intensity ratio (d) at baseline and follow-up (follow-up was available in n=27; mapping parameters were available in n=17). Individual values are represented by the dots at baseline and follow-up cardiac magnetic resonance. The connecting lines show the tendency of change in quantitative parameters over time. P-values were obtained using a paired Student’s t-test

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  Fig. 4. A clinical example of cardiac magnetic resonance imaging (MRI) in a 15-year-old boy with the typical appearance of acute myocarditis on cardiac MRI at baseline and with recovery on follow-up after 2 months. Cardiac MRI in end-diastole shows subepicardial enhancement of the basal lateral wall on late gadolinium enhancement (LGE) images in axial and short-axis (SA) orientation with associated focal myocardial edema (arrows) on fat-suppressed (T2-weighted short TI inversion recovery [T2 STIR]) images (white dashed lines in axial LGE images represent the imaging plane of LGE and T2 STIR). T2 STIR images at follow-up show normalization of focal myocardial edema. Mapping parameters displayed high myocardial native T1 and T2 relaxation times at baseline cardiac MRI and normalization at follow-up. Notably, in this example, T1 and T2 maps cover the transition between the basal and mid segments outside the visible late gadolinium enhancement lesions (orange dashed lines in axial LGE images represent the imaging plane of the quantitative maps) and detected additionally diffuse myocardial alterations in the septal and inferior wall, which normalized at follow-up (arrowheads)

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  Fig. 5. A clinical example of cardiac magnetic resonance imaging (MRI) in short-axis view in a 16-year-old boy. Cine images (balanced steady state free precession [b-SSFP]) show normal left ventricular ejection fraction (LVEF; 58%, no segmental hypokinesia) and pericardial effusion basal inferior (arrow). No focal or diffuse enhancement was identified on late gadolinium enhancement (LGE). No focal myocardial edema was visible on fat-suppressed (T2-weighted short TI inversion recovery [T2 STIR]) images. Mapping parameters displayed high global myocardial native T1 and T2 relaxation times at baseline cardiac MRI and normalization at follow-up (arrowheads show the most affected segments). The diagnosis of acute diffuse myocarditis in this patient was only possible using quantitative parameters according to 2018 Lake Louise criteria and would have been missed by the original Lake Louise criteria