title: The potential additional diagnostic value of assessing for pericardial effusion on cardiac magnetic resonance imaging in patients with suspected myocarditis.
abstract: BACKGROUND
  The presence of pericardial effusion (PE) is considered to be suggestive of inflammation in suspected myocarditis. However, the incremental value of assessing for PE in addition to comprehensive cardiac magnetic resonance (CMR) imaging remains unclear.
  
  
  METHODS
  In total, 132 patients with suspected acute (AMC) or chronic myocarditis (CMC) were included. All patients underwent endomyocardial biopsy (EMB) and CMR. Imaging protocols included T2 imaging for the assessment of myocardial oedema (oedema ratio [ER]), T1 imaging before and after contrast agent administration for global relative enhancement (gRE) calculation, and late enhancement (LE). Furthermore, the presence and extent of PE were determined. The potential incremental diagnostic value of PE was determined by applying a two, three, or four out of four criteria approach including ER, gRE, LE, and PE.
  
  
  RESULTS
  PE was present in 84 of the 132 patients (63.6%) and was more common in suspected AMC vs. CMC (56 of 70 vs. 28 of 62; P < 0.001). According to EMB results, PE was found in 86% of patients with AMC, 67% with chronic myocarditis, and 56% without evidence of myocardial inflammation. Implementing PE into a three out of four approach did not result in improved accuracy compared with the established two out of three approach using ER, gRE, and LE (59 vs. 68% for the total population, 69 vs. 79% for suspected AMC, and 48 vs. 52% for suspected CMC).
  
  
  CONCLUSIONS
  The finding of PE in unselected patients with suspected AMC or CMC is not specific to myocarditis. Therefore, with the currently applied criteria and methods, assessment of PE does not improve the diagnostic performance of CMR in this patient cohort.
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany philipp.lurz@gmx.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Klieme
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heart Center of the University Leipzig, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Luecke
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.affiliation: Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heart Center of the University Leipzig, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heart Center of the University Leipzig, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002908:Chronic Disease; D015331:Cohort Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000453:epidemiology; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media
keywords: Cardiac magnetic resonance imaging; Myocarditis; Pericardial effusion