Abstract
We compared a fast, single breath-hold three dimensional LGE sequence (3D LGE) with an established two dimensional multi breath-hold sequence (2D LGE) and evaluated image quality and the amount of myocardial fibrosis in patients with acute and chronic myocarditis. 3D LGE and 2D LGE (both spatial resolution 1.5 × 1.5 mm2, slice-thickness 8 mm, field of view 350 × 350 mm2) were acquired in 25 patients with acute myocarditis (mean age 40 ± 18 years, 7 female) and 27 patients with chronic myocarditis (mean age 44 ± 22 years, 9 female) on a 1.5 T MR system. Image quality was evaluated by two independent, blinded readers using a 5-point Likert scale. Total myocardial mass, fibrotic mass and total fibrotic tissue percentage were quantified for both sequences in both groups. There was no significant difference in image quality between 3D und 2D acquisitions in patients with acute (p = 0.8) and chronic (p = 0.5) myocarditis. No significant differences between 3D and 2D acquisitions could be shown for myocardial mass (acute p = 0.2; chronic p = 0.3), fibrous tissue mass (acute p = 0.7; chronic p = 0.1) and total fibrous percentage (acute p = 0.4 and chronic p = 0.2). Inter-observer agreement was substantial to almost perfect. Acquisition time was significantly shorter for 3D LGE (24 ± 5 s) as compared to 2D LGE (350 ± 58 s, p < 0.001). In patients with acute and chronic myocarditis 3D LGE imaging shows equal diagnostic quality compared to standard 2D LGE imaging but with significantly reduced acquisition time.
Highlights
Cardiac magnetic resonance imaging (MRI) has an exclusive role in the noninvasive detection of myocarditis [1]
Late gadolinium enhancement (LGE) imaging comprises a high sensitivity for the detection of focal fibrotic tissue, which can be commonly found in myocarditis [2]
Single breath-hold 3D LGE imaging has been established for ischemic scars and cardiomyopathies, providing comparable image quality to multi breath-hold 2D LGE [18, 23, 24]
Summary
Cardiac magnetic resonance imaging (MRI) has an exclusive role in the noninvasive detection of myocarditis [1]. Late gadolinium enhancement (LGE) imaging comprises a high sensitivity for the detection of focal fibrotic tissue, which can be commonly found in myocarditis [2]. It has been shown that the presence of myocardial fibrosis has diagnostic and prognostic value in patients with acute and chronic myocarditis [6,7,8,9]. The International Journal of Cardiovascular Imaging (2021) 37:305–313 declined, residual myocardial scars can persist and trigger arrhythmias or cardiovascular complications [10]. Diagnosing fibrous tissue is of critical importance, even if symptoms of acute myocarditis have already vanished or have never occurred in the first place
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