Key result
Combined cardiac MRI parameters yield ~91% specificity but low sensitivity for diagnosing acute myocarditis.
Why the study?
The role of MRI in diagnosing acute myocarditis by correlation with immunohistological parameters was evaluated due to uncertainty in diagnostic reliability of MRI parameters alone.
Does MRI accurately diagnose acute myocarditis compared to immunohistology in patients with suspected acute myocarditis?
Observational (n=131)
Does MRI accurately diagnose acute myocarditis compared to immunohistology in patients with suspected acute myocarditis?
MRI parameters alone cannot reliably diagnose acute myocarditis, but combining relative enhancement, relative water content, and late enhancement improves diagnostic specificity.
Low sensitivity limits ruling out acute myocarditis by cardiac MRI; leaves open validation of refined protocols against immunohistology.
OBJECTIVE: To evaluate the role of MRI in diagnosing acute myocarditis by correlation with immunohistological parameters. METHODS: A total of 131 patients (85 men, 46 women; mean age, 44.9 years) with suspected acute myocarditis were examined by MRI. The relative water content of the left ventricular myocardium as well as relative and late enhancement was correlated with the immunohistological results in biopsy specimens. RESULTS: Myocardial inflammation was confirmed by immunohistology in 82 of the 131 patients investigated and ruled out in 49 patients. The sensitivity, specificity and accuracy for diagnosing myocarditis in patients with immunohistologically proven disease were 48.8%, 73.8% and 57.3%, respectively, for relative enhancement, 58.3%, 57.1% and 57.9% for relative water content, and 30.6%, 88.1% and 49.6% for late enhancement. A combination of all three parameters had 39,3% sensitivity and 91,3% specificity and 62,7% accuracy. Relative enhancement and late enhancement significantly correlated with the presence of myocarditis but relative oedema did not. CONCLUSION: Relative and late enhancement significantly correlate with the presence of myocarditis, while there is no significant correlation for relative oedema. Myocarditis cannot be reliably diagnosed using any of the three MRI parameters alone but combinations of parameters will improve specificity.
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Röttgen et al. (2010) conducted an observational in Suspected acute myocarditis (n=131). Cardiac MRI (relative enhancement, relative water content, late enhancement) vs. Immunohistological findings (reference standard) was evaluated on Diagnostic performance of combined MRI parameters (relative edema, relative enhancement, late enhancement) for acute myocarditis (Sensitivity 39.3%, Specificity 91.3%, Accuracy 62.7%, p=0.013). A combination of relative edema, relative enhancement, and late enhancement on cardiac MRI yielded a sensitivity of 39.3% and a specificity of 91.3% for diagnosing acute myocarditis compared to immunohistology.
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