title: Performance of t1 and t2 mapping cardiovascular magnetic resonance to detect active myocarditis in patients with recent-onset heart failure.
abstract: BACKGROUND
  This study evaluated the performance of novel quantitative T1 and T2 mapping cardiovascular magnetic resonance (CMR) techniques to identify active myocarditis in patients with recent-onset heart failure.
  
  
  RESULTS
  Thirty-one consecutive patients with recent-onset heart failure, reduced left ventricular function and clinically suspected myocarditis underwent endomyocardial biopsy and CMR at 1.5 Tesla. The CMR protocol included standard Lake-Louise parameters as well as T1 mapping using a modified Look-Locker inversion recovery sequence and T2 mapping using a hybrid gradient and spin-echo sequence. Short-axis maps were generated using an OsiriX plug-in to calculate global myocardial T1, T2, and extracellular volume fraction. Active myocarditis was defined by ongoing inflammation on endomyocardial biopsy. Endomyocardial biopsy revealed active myocarditis in 16 (52%) of 31 patients. Neither clinical characteristics, standard Lake-Louise CMR parameters, global myocardial T1 nor extracellular volume fraction differed significantly between patients with and without active myocarditis. However, median global myocardial T2 was significantly higher in patients with active myocarditis (65 ms [Q1-Q3, 61-70 ms]) than in patients without active myocarditis (59 ms [Q1-Q3, 55-64 ms]; P<0.01). A cutoff value for global myocardial T2 of ≥60 ms provided a sensitivity, specificity, accuracy, negative and positive predictive value of 94% (70%-100%), 60% (32%-84%), 77% (60%-89%), 90% (56%-100%), and 71% (48%-89%) for active myocarditis, respectively.
  
  
  CONCLUSIONS
  T2 mapping seems to be superior when compared with standard CMR parameters, global myocardial T1, and extracellular volume fraction values for assessing the activity of myocarditis in patients with recent-onset heart failure and reduced left ventricular function.
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bohnen
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Ulf K
authors.initials: UK
authors.lastname: Radunski
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Gunnar K
authors.initials: GK
authors.lastname: Lund
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Christian
authors.initials: C
authors.lastname: Stehning
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: From the University Heart Center, Department of General and Interventional Cardiology (S.B., U.K.R., S.B., K.M.) and Department of Diagnostic and Interventional Radiology (G.K.L., G.A.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Molecular Pathology, University of Tuebingen, Tuebingen, Germany (R.K.); Philips Research Hamburg, Hamburg, Germany (C.S.); and Philips Healthcare Germany, Hamburg, Germany (B.S.). ka.muellerleile@uke.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Muellerleile
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: edema; heart failure; myocarditis; ventricular function, left