Early T1 myocardial MRI mapping: Value in detecting myocardial hyperemia in acute myocarditis

Anna Palmisano, Giulia Benedetti, Riccardo Faletti, Paola M.V. Rancoita, Marco Gatti, Giovanni Peretto, Simone Sala, Edda Boccia, Marco Francone, Nicola Galea, Cristina Basso, Alessandro Del Maschio, Francesco De Cobelli, Antonio Esposito

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hyperemia is a key component of acute myocarditis (AM). Early gadolinium uptake because of myocardial hyperemia may be quantified by using T1 mapping. Purpose: To evaluate the value of early enhanced T1 shortening for the diagnosis of acute myocarditis. Materials and Methods: Study participants suspected of having AM and healthy control (HC) participants were prospectively enrolled from September 2016 to May 2019. Participants underwent 1.5-T cardiac MRI including Lake Louise criteria, T2 mapping, native T1, and extracellular volume, with the addition of early enhanced T1 mapping (2 minutes after intravenous administration of 0.15 mmol/kg gadobutrol). Color-coded maps of the percentage of T1 shortening from precontrast to early postcontrast were generated. Optimal early T1 shortening cut-off value and its diagnostic performance in the identification of acute myocarditis were calculated. Results: Forty-five study participants with AM (median age, 40 years; interquartile range [IQR], 20–46 years; 22 women) diagnosed according to multidisciplinary clinical evaluation, electrocardiography, laboratory test, echocardiography, cardiac MRI, and coronary CT and/or invasive angiography. Findings were confirmed by endomyocardial biopsy in 64% (29 of 45) of participants. MRI parameters were compared with 19 HC participants (median age, 39 years; IQR, 28–46 years; seven women). Median early T1 shortening was 75% (IQR, 72%–78%) in participants with AM versus 65% (IQR, 61%–66%) in HC participants (P , .001). Early T1 shortening showed high diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.97; 95% confidence interval [CI]: 0.94, 1.00) and excellent interobserver reproducibility (intraclass correlation coefficient: 0.98; 95% CI: 0.96, 1.00). Early T1 shortening of 70% or greater identified acute myocarditis with 93% sensitivity, 100% specificity, and 95% diagnostic accuracy. Early T1 shortening had better diagnostic performance than late percentage T1 shortening (AUC, 0.97 vs 0.90, respectively; P = .03) and extracellular volume (AUC, 0.97 vs 0.88, respectively; P = .046), and similar to native T1 (AUC, 0.97 vs 0.93, respectively; P = .63) and T2 mapping (AUC, 0.97 vs 0.97, respectively; P . .99). Conclusion: In this proof-of-concept study, percentage of T1 shortening at early enhanced T1 mapping showed high accuracy for the diagnosis of acute myocarditis.

Original languageEnglish
Pages (from-to)316-325
Number of pages10
JournalRadiology
Volume295
Issue number2
DOIs
Publication statusPublished - May 1 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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