Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis
Comparison of Different Approaches
Hassan Abdel-Aty, MD*,
Philipp Boyé, MD*,
Anja Zagrosek, MD*,
Ralf Wassmuth, MD*,
Andreas Kumar, MD*,
Daniel Messroghli, MD*,
Petra Bock, MD*,
Rainer Dietz, MD*,
Matthias G. Friedrich, MD, FESC*, and
Jeanette Schulz-Menger, MD*,*
* Franz-Volhard-Klinik, Charité Campus Buch, Universität Medizin Berlin, Berlin, Germany
Stephenson CMR Centre, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Alberta, Canada
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Figure 1 Cardiovascular magnetic resonance images from Patient #6. (Top) Pre- and postcontrast axial T1-weighted spin echo images of the same slice. Global relative enhancement was elevated (4.6). Regions of interest are drawn around the myocardium and within the skeletal muscle. (Middle) Short-axis T2-weighted images: no focal areas of high T2 signal, yet the higher global myocardial T2 signal in relation to the skeletal muscle is visibly appreciable (exact value = 2.5). (Bottom) Corresponding late enhancement images: no evidence of late gadolinium enhancement.
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Figure 2 Cardiovascular magnetic resonance findings in Patient #21. (Top) Pre- and postcontrast axial T1-weighted spin echo images of the same slice. Global relative enhancement was elevated (4.1). (Middle) T2-weighted images in three short-axis slices. Note the posterolateral focal high T2 signal (arrowheads) in the basal slice with apparent focal increase in myocardial thickness. (Bottom) Corresponding late enhancement images: no evidence of late gadolinium enhancement.
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Figure 3 Receiver operating characteristic curves for global relative enhancement (solid line) and global relative T2 signal (broken line).
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Figure 4 Representative images from 3 patients (#8, #12, and #14 from left to right, respectively). (Top) Late gadolinium enhancement (LGE). (Bottom) T2-weighted. Focal high T2 signal (thin arrows) corresponds to areas of LGE (arrowheads) in Patients #8 and #12 but not in Patient #14. Note the predominant epicardial distribution of high T2 signal in Patient #12. Small pericardial effusion is seen in Patient #8 (thick curved arrow).
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Figure 5 Diagnostic performance of T2, late gadolinium enhancement (LGE), and global relative enhancement (GRE) as compared to the "any-two" approach. Spotted bars = sensitivity; diagonal striped bars = specificity; solid bars = diagnostic accuracy.
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