Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis

Antonio Esposito, Marco Francone, Riccardo Faletti, Maurizio Centonze, Filippo Cademartiri, Iacopo Carbone, Roberto De Rosa, Ernesto Di Cesare, Ludovico La Grutta, Guido Ligabue, Luigi Lovato, Erica Maffei, Riccardo Marano, Massimo Midiri, Gianluca Pontone, Luigi Natale, Francesco De Cobelli

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages: • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.

Original languageEnglish
Pages (from-to)99-110
Number of pages12
JournalInsights into Imaging
Volume7
Issue number1
DOIs
Publication statusPublished - Feb 1 2016

Fingerprint

Myocarditis
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Light
Cardiomyopathies
Inflammation

Keywords

  • Acute myocarditis
  • Cardiac magnetic resonance
  • Lake Louise criteria
  • T1 mapping

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis. / Esposito, Antonio; Francone, Marco; Faletti, Riccardo; Centonze, Maurizio; Cademartiri, Filippo; Carbone, Iacopo; De Rosa, Roberto; Di Cesare, Ernesto; La Grutta, Ludovico; Ligabue, Guido; Lovato, Luigi; Maffei, Erica; Marano, Riccardo; Midiri, Massimo; Pontone, Gianluca; Natale, Luigi; De Cobelli, Francesco.

In: Insights into Imaging, Vol. 7, No. 1, 01.02.2016, p. 99-110.

Research output: Contribution to journalArticle

Esposito, A, Francone, M, Faletti, R, Centonze, M, Cademartiri, F, Carbone, I, De Rosa, R, Di Cesare, E, La Grutta, L, Ligabue, G, Lovato, L, Maffei, E, Marano, R, Midiri, M, Pontone, G, Natale, L & De Cobelli, F 2016, 'Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis', Insights into Imaging, vol. 7, no. 1, pp. 99-110. https://doi.org/10.1007/s13244-015-0444-7
Esposito, Antonio ; Francone, Marco ; Faletti, Riccardo ; Centonze, Maurizio ; Cademartiri, Filippo ; Carbone, Iacopo ; De Rosa, Roberto ; Di Cesare, Ernesto ; La Grutta, Ludovico ; Ligabue, Guido ; Lovato, Luigi ; Maffei, Erica ; Marano, Riccardo ; Midiri, Massimo ; Pontone, Gianluca ; Natale, Luigi ; De Cobelli, Francesco. / Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis. In: Insights into Imaging. 2016 ; Vol. 7, No. 1. pp. 99-110.
@article{15561a09e88f48a7b608261e026b6b32,
title = "Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis",
abstract = "Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages: • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.",
keywords = "Acute myocarditis, Cardiac magnetic resonance, Lake Louise criteria, T1 mapping",
author = "Antonio Esposito and Marco Francone and Riccardo Faletti and Maurizio Centonze and Filippo Cademartiri and Iacopo Carbone and {De Rosa}, Roberto and {Di Cesare}, Ernesto and {La Grutta}, Ludovico and Guido Ligabue and Luigi Lovato and Erica Maffei and Riccardo Marano and Massimo Midiri and Gianluca Pontone and Luigi Natale and {De Cobelli}, Francesco",
year = "2016",
month = "2",
day = "1",
doi = "10.1007/s13244-015-0444-7",
language = "English",
volume = "7",
pages = "99--110",
journal = "Insights into Imaging",
issn = "1869-4101",
publisher = "Springer Science and Business Media Deutschland GmbH",
number = "1",

}

TY - JOUR

T1 - Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis

AU - Esposito, Antonio

AU - Francone, Marco

AU - Faletti, Riccardo

AU - Centonze, Maurizio

AU - Cademartiri, Filippo

AU - Carbone, Iacopo

AU - De Rosa, Roberto

AU - Di Cesare, Ernesto

AU - La Grutta, Ludovico

AU - Ligabue, Guido

AU - Lovato, Luigi

AU - Maffei, Erica

AU - Marano, Riccardo

AU - Midiri, Massimo

AU - Pontone, Gianluca

AU - Natale, Luigi

AU - De Cobelli, Francesco

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages: • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.

AB - Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. Main messages: • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.

KW - Acute myocarditis

KW - Cardiac magnetic resonance

KW - Lake Louise criteria

KW - T1 mapping

UR - http://www.scopus.com/inward/record.url?scp=84961298461&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961298461&partnerID=8YFLogxK

U2 - 10.1007/s13244-015-0444-7

DO - 10.1007/s13244-015-0444-7

M3 - Article

AN - SCOPUS:84961298461

VL - 7

SP - 99

EP - 110

JO - Insights into Imaging

JF - Insights into Imaging

SN - 1869-4101

IS - 1

ER -