Key result
In acute myocarditis, 5-minute LGE yields ~44% greater contrast than 15-minute imaging, unlike in MI.
Why the study?
The kinetics of gadolinium in myocarditis compared to myocardial infarction and the optimal timing for LGE image acquisition in acute myocarditis were not established.
Does the timing of LGE image acquisition after gadolinium injection affect image contrast and quality in patients with acute myocarditis compared to acute myocardial infarction?
Observational (n=29)
Does the timing of LGE image acquisition after gadolinium injection affect image contrast and quality in patients with acute myocarditis compared to acute myocardial infarction?
Absolute Event Rate: 60.7% vs 42.1%
p-value: p=0.001
LGE images acquired 5 minutes after gadolinium injection provide better contrast and image quality for diagnosing acute myocarditis compared to later time points.
Early LGE at 5 min may improve myocarditis contrast; leaves open protocol changes pending larger validation.
OBJECTIVES: To compare the kinetics of gadolinium in myocarditis and myocardial infarction and to establish the best interval between contrast injection and late gadolinium-enhanced (LGE) image acquisition for the diagnosis of acute myocarditis. METHODS: Seventeen patients with acute myocarditis and 12 with acute myocardial infarction underwent Look-Locker sequences before and after administration of 0.2 mmol/kg gadolinium chelate for a period of 14 minutes. The apparent longitudinal relaxation rates (R'1) were calculated from left ventricular blood, enhanced and normal myocardium. LGE cardiac magnetic resonance images were acquired at 5, 10, and 15 minutes after contrast injection. The contrast between enhanced and normal myocardium (Contrastenhaced-normal) was measured, and the quality of the images was analyzed. RESULTS: A faster decline in the R'1 values measured in the areas of myocardial enhancement was recorded in myocarditis than that in myocardial infarction. In myocarditis, the Contrastenhaced-normal values decreased over time (from 60.7 ± 35.1 at 5 minutes vs. 42.1 ± 26.7 at 15 minutes; P = 0.001). However, in myocardial infarction, the Contrastenhaced-normal value remained stable in time (60.7 ± 22.9 at 5 minutes vs. 68.8 ± 16.6 at 15 minutes; P = ns). CONCLUSION: The gadolinium kinetics of acute myocarditis are different from those of acute myocardial infarction. In myocarditis, LGE images acquired 5 minutes after contrast injection provide higher Contrastenhaced-normal and better image quality compared with images taken at later points.
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Jacquier et al. (2011) conducted an observational in Acute myocarditis and acute myocardial infarction (n=29). LGE imaging at 5 minutes vs. LGE imaging at 15 minutes was evaluated on Contrast between enhanced and normal myocardium in acute myocarditis (p=0.001). In acute myocarditis, LGE images acquired 5 minutes after gadolinium injection provided higher contrast than at 15 minutes (60.7 vs 42.1; P=0.001), unlike in myocardial infarction where it remained stable.
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