title: Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis.
abstract: BACKGROUND
  The course of tissue changes in acute myocarditis in humans is not well understood. Diagnostic tools currently available are unsatisfactory. We tested the hypothesis that inflammation is reflected by signal changes in contrast-enhanced magnetic resonance imaging (MRI).
  
  
  RESULTS
  We assessed 44 consecutive patients with symptoms of acute myocarditis. Nineteen patients met the inclusion criteria revealing ECG changes, reduced myocardial function, elevated creatine kinase, positive troponin T, serological evidence for acute viral infection, exclusion of coronary heart disease, and positive antimyosin scintigraphy. We studied these patients on days 2, 7, 14, 28, and 84 after the onset of symptoms. We obtained ECG-triggered, T1-weighted images before and after application of 0.1 mmol/kg gadolinium. We measured the global relative signal enhancement of the left ventricular myocardium related to skeletal muscle and compared it with measurements in 18 volunteers. The global relative enhancement was higher in patients on days 2 (4.8+/-0.3 [mean+/-SE] versus 2.5+/-0.2; P<.0001); 7 (4.7+/-0.5, P<.0001); 14 (4.6+/-0.5, P<.0002); and 28 (3.9+/-0.4, P=.009) but not on day 84 (3.1+/-0.3; P=NS). On day 2, the enhancement was focal, whereas at later time points, the enhancement was diffuse. In patients with evidence of ongoing disease, the values remained elevated.
  
  
  CONCLUSIONS
  Acute myocarditis evolves from a focal to a disseminated process during the first 2 weeks after onset of symptoms. Contrast media-enhanced MRI visualizes the localization, activity, and extent of inflammation and may serve as a powerful noninvasive diagnostic tool in acute myocarditis.
authors.affiliation: Franz-Volhard-Klinik am Max Delbrück Centrum für Molekulare Medizin, Virchow Klinikum, Humboldt Universität zu Berlin, Germany. friedrich@fvk-berlin.de
authors.forename: M G
authors.initials: MG
authors.lastname: Friedrich
authors.forename: O
authors.initials: O
authors.lastname: Strohm
authors.forename: J
authors.initials: J
authors.lastname: Schulz-Menger
authors.forename: H
authors.initials: H
authors.lastname: Marciniak
authors.forename: F C
authors.initials: FC
authors.lastname: Luft
authors.forename: R
authors.initials: R
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003287:Contrast Media; D004699:Endocardium / Q000473:pathology; D019786:Gadolinium DTPA; D006334:Heart Function Tests; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009205:Myocarditis / Q000473:pathology* / Q000821:virology; D009206:Myocardium / Q000473:pathology*; D012720:Severity of Illness Index; D014777:Virus Diseases / Q000473:pathology* / Q000821:virology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA