title: Accuracy of cardiovascular magnetic resonance in myocarditis: comparison of MR and histological findings in an animal model.
abstract: BACKGROUND
  Because endomyocardial biopsy has low sensitivity of about 20%, it can be performed near to myocardium that presented as late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR). However the important issue of comparing topography of CMR and histological findings has not yet been investigated. Thus the current study was performed using an animal model of myocarditis.
  
  
  RESULTS
  In 10 male Lewis rats experimental autoimmune myocarditis was induced, 10 rats served as control. On day 21 animals were examined by CMR to compare topographic distribution of LGE to histological inflammation. Sensitivity, specificity, positive and negative predictive values for LGE in diagnosing myocarditis were determined for each segment of myocardium. Latter diagnostic values varied widely depending on topographic distribution of LGE and inflammation as well as on the used CMR sequence. Sensitivity of LGE was up to 76% (left lateral myocardium) and positive predictive values were up to 85% (left lateral myocardium), whereas sensitivity and positive predictive value dropped to 0-33% (left inferior myocardium).
  
  
  CONCLUSIONS
  Topographic distribution of LGE and histological inflammation seem to influence sensitivity, specificity, positive and negative predictive values. Nevertheless, positive predictive value for LGE of up to 85% indicates that endomyocardial biopsy should be performed "MR-guided". LGE seems to have greater sensitivity than endomyocardial biopsy for the diagnosis of myocarditis.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. huedayi.korkusuz@kgu.de
authors.forename: Huedayi
authors.initials: H
authors.lastname: Korkusuz
authors.forename: Philip
authors.initials: P
authors.lastname: Esters
authors.forename: Frank
authors.initials: F
authors.lastname: Huebner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Bug
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003287:Contrast Media; D004195:Disease Models, Animal; D004699:Endocardium / Q000378:metabolism / Q000473:pathology*; D019786:Gadolinium DTPA; D006242:Haptoglobins / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D009205:Myocarditis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D051381:Rats; D011917:Rats, Inbred Lew; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D006242:Haptoglobins; D020107:Troponin T; D019786:Gadolinium DTPA
references.citation: Tidsskr Nor Laegeforen. 2008 May 15;128(10):1172-4
references.pmid: 18480866
references.citation: Clin Immunol Immunopathol. 1990 Nov;57(2):250-62
references.pmid: 2208806
references.citation: Exp Toxicol Pathol. 1995 May;47(2-3):121-7
references.pmid: 7580098
references.citation: J Am Coll Cardiol. 2008 Apr 22;51(16):1581-7
references.pmid: 18420102
references.citation: Eur J Pharmacol. 2008 Feb 26;581(1-2):121-31
references.pmid: 18154949
references.citation: Circulation. 2004 Mar 16;109(10):1250-8
references.pmid: 14993139
references.citation: Circ J. 2007 Mar;71(3):397-404
references.pmid: 17322642
references.citation: Ann Intern Med. 1988 Oct 1;109(7):525-8
references.pmid: 3048160
references.citation: Medicine (Baltimore). 1999 Jul;78(4):270-83
references.pmid: 10424207
references.citation: Radiology. 2008 Feb;246(2):401-9
references.pmid: 18180335
references.citation: Circulation. 2008 Aug 5;118(6):639-48
references.pmid: 18645053
references.citation: Methods. 2007 Sep;43(1):35-45
references.pmid: 17720562
references.citation: Arch Toxicol. 2003 Jul;77(7):392-402
references.pmid: 12669191
references.citation: J Cardiovasc Pharmacol. 2004 Jun;43(6):868-75
references.pmid: 15167281
references.citation: Circulation. 1998 May 12;97(18):1802-9
references.pmid: 9603535
references.citation: J Am Coll Cardiol. 2005 Jun 7;45(11):1815-22
references.pmid: 15936612
references.citation: Clin Res Cardiol. 2007 Oct;96(10):759-62
references.pmid: 17694383
references.citation: J Am Coll Cardiol. 2006 Apr 18;47(8):1649-54
references.pmid: 16631005
references.citation: Eur Radiol. 2009 Nov;19(11):2672-8
references.pmid: 19458951
references.citation: J Am Coll Cardiol. 2009 Apr 28;53(17):1475-87
references.pmid: 19389557
references.citation: Br J Anaesth. 1999 May;82(5):723-30
references.pmid: 10536551
references.citation: J Am Coll Cardiol. 1992 Jul;20(1):85-9
references.pmid: 1607543
references.citation: J Am Coll Cardiol. 1989 Oct;14(4):915-20
references.pmid: 2794278
references.citation: J Am Coll Cardiol. 2006 Nov 21;48(10):2085-93
references.pmid: 17112998
references.citation: Nihon Yakurigaku Zasshi. 2004 Feb;123(2):63-70
references.pmid: 14745125
references.citation: Circulation. 2006 Oct 10;114(15):1581-90
references.pmid: 17015795
references.citation: Med Klin (Munich). 2005 Sep 15;100(9):553-61
references.pmid: 16170644
references.citation: Circulation. 2004 May 25;109(20):2411-6
references.pmid: 15123531
references.citation: Ther Umsch. 2001 Feb;58(2):87-93
references.pmid: 11234456
references.citation: Circ Res. 1991 Oct;69(4):1042-50
references.pmid: 1934332
references.citation: N Engl J Med. 2000 Nov 9;343(19):1388-98
references.pmid: 11070105