Abstract
BackgroundThe diagnostic value of cardiac magnetic resonance imaging (MRI) employing the 2018 Lake Louise criteria in pediatric and adolescent patients with acute myocarditis is undefined.ObjectiveTo evaluate the diagnostic value of the Lake Louise criteria in pediatric and adolescent patients with suspected acute myocarditis and to show the utility of cardiac MRI for follow-up in this patient cohort.Materials and methodsForty-three patients (age range: 8–21 years) with suspected acute myocarditis and 13 control patients who underwent cardiac MRI were retrospectively analyzed. T2-weighted and late gadolinium enhancement imaging were performed in all patients. T1 and T2 mapping were available in 26/43 patients (60%). The Lake Louise criteria were assessed. In 27/43 patients (63%), cardiac MRI follow-up was available. Receiver operating characteristic analysis, Pearson’s correlation coefficient and paired Student’s t-test were used for statistical analysis.ResultsIn the total cohort, the Lake Louise criteria achieved a sensitivity of 86% (95% confidence interval [CI]: 72–95%) and a specificity of 100% (95% CI: 79–100%) for the diagnosis of acute myocarditis. In the subgroup of patients with available mapping parameters, the diagnostic performance of the Lake Louise criteria was higher when mapping parameters were implemented into the score (area under the receiver operating characteristic curve: 0.944 vs. 0.870; P=0.033). T2 relaxation times were higher in patients with admission to the intermediate care unit and were associated with the length of intermediate care unit stay (r=0.879, P=0.049). Cardiac MRI markers of active inflammation decreased on follow-up examinations (e.g., T1 relaxation times: 1,032±39 ms vs. 975±33 ms, P<0.001; T2 relaxation times: 58±5 ms vs. 54±5 ms, P=0.003).ConclusionThe Lake Louise criteria have a high diagnostic performance for the diagnosis of acute myocarditis and are a valuable tool for follow-up in pediatric and adolescent patients. The mapping techniques enhance the diagnostic performance of the 2018 Lake Louise criteria.
Highlights
Acute myocarditis is an inflammatory disorder of the myocardium primarily caused by infections, autoimmune processes, Pediatr Radiol heterogeneous, varying from fast convalescence to delayed recovery or chronic heart failure and, rarely, serious longterm morbidity [8, 9]
Previous studies evaluated the performance of cardiac magnetic resonance imaging (MRI) diagnostic parameters primary in adults, but the diagnostic value of quantitative parameters remains undetermined in children and adolescents
We evaluated the diagnostic performance of current cardiac MRI criteria for acute myocarditis in pediatric and adolescent patients
Summary
Acute myocarditis is an inflammatory disorder of the myocardium primarily caused by infections, autoimmune processes, Pediatr Radiol heterogeneous, varying from fast convalescence to delayed recovery or chronic heart failure and, rarely, serious longterm morbidity [8, 9]. Cardiac magnetic resonance imaging (MRI) plays an important role for diagnostic work-up in patients with suggested myocarditis. Cardiac MRI is a noninvasive and radiation-free technique that is suitable for pediatric and adolescent patients and can be of particular value to differentiate acute myocarditis from myocardial infarction, primary cardiomyopathy or congenital heart disease to spare young patients from coronary angiography [10, 11]. The Lake Louise criteria were established in 2009 for the diagnosis of myocarditis by cardiac MRI They include three aspects of myocardial inflammation (edema, hyperemia and necrosis) in a two-out-of-three approach (high signal intensities on T2-weighted images, early gadolinium enhancement and late gadolinium enhancement) [12]. The diagnostic value of cardiac magnetic resonance imaging (MRI) employing the 2018 Lake Louise criteria in pediatric and adolescent patients with acute myocarditis is undefined
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