title: Acute myocarditis: multiparametric cardiac MR imaging.
abstract: OBJECTIVE
  To evaluate the diagnostic value of cardiac magnetic resonance (MR) imaging at 3 T in patients suspected of having acute myocarditis by using a multiparametric cardiac MR imaging approach including T1 relaxation time as an additional tool for tissue characterization.
  
  
  METHODS
  Ethics commission approval was obtained for this prospective study, and written informed consent was obtained from all subjects. Twenty four patients with acute myocarditis (mean age ± standard deviation, 34.7 years ± 15.1; 75% men) and 42 control subjects (mean age, 38.7 years ± 10.2; 64% men) were included. Cardiac MR imaging approaches included relative T2 short tau inversion-recovery signal intensity ratio (T2 ratio), early gadolinium enhancement ratio, late gadolinium enhancement, native T1 relaxation times, and extracellular volume fraction. Receiver operating characteristic analysis was performed to compare diagnostic performance. The reference standard was the clinical evidence for acute myocarditis.
  
  
  RESULTS
  Native T1 relaxation times were significantly longer in patients with acute myocarditis than in control subjects (1185.3 msec ± 49.3 vs 1089.1 msec ± 44.9, respectively; P < .001). Areas under the curve of native T1 relaxation times (0.94) were higher compared with those of other cardiac MR parameters (late gadolinium enhancement, 0.90; T2 ratio, 0.79; extracellular volume fraction, 0.71; early gadolinium enhancement ratio, 0.63; P = .390, .018, .002, and < .001, respectively). Sensitivity (92%), specificity (91%), and diagnostic accuracy (91%) for native T1 relaxation times (cutoff, 1140 msec) were equivalent compared with those of the established combined Lake Louise criteria (sensitivity, 92%; specificity, 80%; diagnostic accuracy, 85%).
  
  
  CONCLUSIONS
  Diagnostic performance with native T1 mapping was superior to that with T2 ratio and early gadolinium enhancement ratio, and specificity was higher with native T1 mapping than that with Lake Louise criteria. This study underlines the potential of native T1 relaxation times to complement current cardiac MR approaches in patients suspected of having acute myocarditis.
authors.affiliation: From the Departments of Radiology (J.A.L., J.D., D.K.T., D.D., J.G., A.M.S., R.H., H.S., C.P.N.), Medical Biometry (R.F.), and Cardiology (J.O.S.), University of Bonn, Sigmund-Freud-Str 25, 53127 Bonn, Germany; and Philips Research, Hamburg, Germany (J.G., C.S.).
authors.forename: Julian A
authors.initials: JA
authors.lastname: Luetkens
authors.forename: Jonas
authors.initials: J
authors.lastname: Doerner
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Thomas
authors.forename: Darius
authors.initials: D
authors.lastname: Dabir
authors.forename: Juergen
authors.initials: J
authors.lastname: Gieseke
authors.forename: Alois M
authors.initials: AM
authors.lastname: Sprinkart
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.forename: Christian
authors.initials: C
authors.lastname: Stehning
authors.forename: Rami
authors.initials: R
authors.lastname: Homsi
authors.forename: Joerg O
authors.initials: JO
authors.lastname: Schwab
authors.forename: Hans
authors.initials: H
authors.lastname: Schild
authors.forename: Claas P
authors.initials: CP
authors.lastname: Naehle
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D003287:Contrast Media