Accuracy of cardiovascular magnetic resonance in myocarditis: comparison of MR and histological findings in an animal model.
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.
Korkusuz
Huedayi
H
Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. huedayi.korkusuz@kgu.de
Esters
Philip
P
Huebner
Frank
F
Bug
Reinhold
R
Ackermann
Hanns
H
Vogl
Thomas J
TJ
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
D015415:Biomarkers; D003287:Contrast Media; D006242:Haptoglobins; D020107:Troponin T; D019786:Gadolinium DTPA
Tidsskr Nor Laegeforen. 2008 May 15;128(10):1172-4
18480866
Clin Immunol Immunopathol. 1990 Nov;57(2):250-62
2208806
Exp Toxicol Pathol. 1995 May;47(2-3):121-7
7580098
J Am Coll Cardiol. 2008 Apr 22;51(16):1581-7
18420102
Eur J Pharmacol. 2008 Feb 26;581(1-2):121-31
18154949
Circulation. 2004 Mar 16;109(10):1250-8
14993139
Circ J. 2007 Mar;71(3):397-404
17322642
Ann Intern Med. 1988 Oct 1;109(7):525-8
3048160
Medicine (Baltimore). 1999 Jul;78(4):270-83
10424207
Radiology. 2008 Feb;246(2):401-9
18180335
Circulation. 2008 Aug 5;118(6):639-48
18645053
Methods. 2007 Sep;43(1):35-45
17720562
Arch Toxicol. 2003 Jul;77(7):392-402
12669191
J Cardiovasc Pharmacol. 2004 Jun;43(6):868-75
15167281
Circulation. 1998 May 12;97(18):1802-9
9603535
J Am Coll Cardiol. 2005 Jun 7;45(11):1815-22
15936612
Clin Res Cardiol. 2007 Oct;96(10):759-62
17694383
J Am Coll Cardiol. 2006 Apr 18;47(8):1649-54
16631005
Eur Radiol. 2009 Nov;19(11):2672-8
19458951
J Am Coll Cardiol. 2009 Apr 28;53(17):1475-87
19389557
Br J Anaesth. 1999 May;82(5):723-30
10536551
J Am Coll Cardiol. 1992 Jul;20(1):85-9
1607543
J Am Coll Cardiol. 1989 Oct;14(4):915-20
2794278
J Am Coll Cardiol. 2006 Nov 21;48(10):2085-93
17112998
Nihon Yakurigaku Zasshi. 2004 Feb;123(2):63-70
14745125
Circulation. 2006 Oct 10;114(15):1581-90
17015795
Med Klin (Munich). 2005 Sep 15;100(9):553-61
16170644
Circulation. 2004 May 25;109(20):2411-6
15123531
Ther Umsch. 2001 Feb;58(2):87-93
11234456
Circ Res. 1991 Oct;69(4):1042-50
1934332
N Engl J Med. 2000 Nov 9;343(19):1388-98
11070105