title: Diagnostic performance of CMR imaging compared with EMB in patients with suspected myocarditis.
abstract: OBJECTIVE
  The goal of this study was to assess the diagnostic performance of cardiac magnetic resonance (CMR) compared with endomyocardial biopsy in patients with suspected acute myocarditis (AMC) and chronic myocarditis (CMC).
  
  
  BACKGROUND
  Several studies have reported an encouraging diagnostic performance of CMR in myocarditis. However, the comparison of CMR with clinical data only and the use of preselected patient populations are important limitations of the majority of these reports.
  
  
  METHODS
  One hundred thirty-two consecutive patients with suspected AMC (defined by symptoms ≤ 14 days; n = 70) and CMC (defined by symptoms >14 days; n = 62) were included. Patients underwent cardiac catheterization with left ventricular endomyocardial biopsy and CMR, including T(2)-weighted imaging for assessment of edema, T(1)-weighted imaging before and after contrast administration for evaluation of hyperemia, and assessment of late gadolinium enhancement. CMR results were considered to be consistent with the diagnosis of myocarditis if 2 of 3 CMR techniques were positive.
  
  
  RESULTS
  Within the total population, myocarditis was the most common diagnosis on endomyocardial biopsy analysis (62.9%). Viral genomes were detected in 30.3% (40 of 132) of patients within the total patient population and significantly more often in patients with AMC than CMC (40.0% vs. 19.4%; p = 0.013). For the overall cohort of patients with either suspected AMC or CMC, the diagnostic sensitivity, specificity, and accuracy of CMR were 76%, 54%, and 68%, respectively. The best diagnostic performance was observed in patients with suspected AMC (sensitivity, 81%; specificity, 71%; and accuracy, 79%). In contrast, diagnostic performance of CMR in suspected CMC was found to be unsatisfactory (sensitivity, 63%; specificity, 40%; and accuracy, 52%).
  
  
  CONCLUSIONS
  The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. Philipp.Lurz@gmx.de
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Julia
authors.initials: J
authors.lastname: Adam
authors.forename: Julia
authors.initials: J
authors.lastname: Steiner
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.forename: Mahdi
authors.initials: M
authors.lastname: Sareban
authors.forename: Christian
authors.initials: C
authors.lastname: Luecke
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003287:Contrast Media; D004489:Edema, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005858:Germany; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media