Abstract
BackgroundThe purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection.MethodsCardiovascular magnetic resonance (CMR) data of 31 patients with ACM were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. Additionally to the routine CMR protocol, T2-mapping data were acquired at 1.5 T using a breathhold Gradient-Spin-Echo T2-mapping sequence in six short axis slices. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values as well as the segmental pixel-standard deviation (SD) were analyzed.ResultsMean differences of global myocardial T2 or pixel-SD between HV and ACM patients were only small, lying in the normal range of HV. In contrast, variation of segmental T2 values and pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD) of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and ACM patients with an AUC of 0.85 in ROC-analysis. In classification trees, a combined cut-off of 0.22 for madSD and of 68 ms for maxT2 resulted in 83 % specificity and 81 % sensitivity for detection of ACM.ConclusionsThe proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity and therefore have the potential to overcome the hurdles of T2-mapping for its integration into clinical routine.
Highlights
The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection
It has the potential to identify the various hallmarks of myocardial inflammation, including edema, hyperemia and fibrosis by using T2-weighted imaging, early and Baeßler et al Journal of Cardiovascular Magnetic Resonance (2015) 17:115 late gadolinium enhancement (EGE, LGE), referred to as the Lake Louise consensus criteria (LL criteria) [6]
T2-mapping in cardiovascular magnetic resonance (CMR)-proven ACM Global myocardial T2 times in ACM patients were significantly higher compared to healthy volunteers (HV) (Table 3, Fig. 1a), this small difference yielded an only small to medium effect size (Table 3) and did not exceed the normal range of T2 values in HV (Table 2)
Summary
The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection. Acute myocarditis (ACM) is one of the leading causes of sudden cardiac death in young adults and is found in up to 20 % of autopsy cases [1]. It represents a frequent precursor of dilated cardiomyopathy (DCM) [2]. It has the potential to identify the various hallmarks of myocardial inflammation, including edema, hyperemia and fibrosis by using T2-weighted imaging, early and Baeßler et al Journal of Cardiovascular Magnetic Resonance (2015) 17:115 late gadolinium enhancement (EGE, LGE), referred to as the Lake Louise consensus criteria (LL criteria) [6]. Considering that the difference between remote and edematous myocardium has been reported to be in the range of 10–20 ms [7, 10], we hypothesized that dedicated segmental reference values are needed for a future diagnostic decision making
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