Key result
A multiparametric CMR imaging model combining madSD, global circumferential strain, and late gadolinium enhancement yielded an excellent diagnostic performance (AUC 0.93) for acute myocarditis, superior to traditional Lake Louise criteria (AUC 0.79).
Why the study?
Does a multiparametric CMR imaging approach using T2-mapping and feature tracking improve diagnostic accuracy for acute myocarditis compared to traditional Lake Louise criteria?
Case-Control (n=84)
Blinded analysis
No
Does a multiparametric CMR imaging approach using T2-mapping and feature tracking improve diagnostic accuracy for acute myocarditis compared to traditional Lake Louise criteria?
Absolute Event Rate: 0.93% vs 0.79%
A multiparametric CMR approach combining T2-mapping, feature tracking strain, and LGE significantly improves the diagnostic sensitivity for acute myocarditis compared to traditional Lake Louise criteria.
May support multiparametric CMR for myocarditis diagnosis; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: 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). METHODS: 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. RESULTS: ) 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%. CONCLUSIONS: and LGE yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to LLC.
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Baeßler et al. (2016) conducted a case-control in Suspected acute myocarditis (n=84). Multiparametric CMR imaging (madSD, GCS LV, and LGE) vs. Lake Louise criteria (LLC) was evaluated on Diagnostic performance (Area Under the Curve) for acute myocarditis. A multiparametric CMR imaging model combining madSD, global circumferential strain, and late gadolinium enhancement yielded an excellent diagnostic performance (AUC 0.93) for acute myocarditis, superior to traditional Lake Louise criteria (AUC 0.79).
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