title: Incremental value of quantitative CMR including parametric mapping for the diagnosis of acute myocarditis.
abstract: OBJECTIVE
  Cardiac magnetic resonance (CMR) can visualize inflammatory tissue changes in acute myocarditis. Several quantitative image-derived parameters have been described to enhance the diagnostic value of CMR, but no direct comparison of these techniques is available.
  
  
  RESULTS
  A total of 34 patients with suspected acute myocarditis and 50 control subjects underwent CMR. CMR protocol included quantitative assessment of T1 relaxation times using modified Look-Locker inversion recovery (MOLLI) and shortened MOLLI (ShMOLLI) acquisition schemes, extracellular volume fraction (ECV), T2 relaxation times, and longitudinal strain. Established Lake-Louise criteria (LLC) consisting of T2-weighted signal intensity ratio (T2-ratio), early gadolinium enhancement ratio (EGEr), and late gadolinium enhancement (LGE) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic performance. Areas under the curve of native T1 (MOLLI: 0.95; ShMOLLI: 0.92) and T2 relaxation times (0.92) were higher compared with those of the other CMR parameters (T2-ratio: 0.71, EGEr: 0.71, LGE: 0.87, LLC: 0.90, ECV MOLLI: 0.77, ECV ShMOLLI: 0.80, longitudinal strain: 0.83). Combined with LGE, each native mapping technique outperformed the diagnostic performance of LLC (P < 0.01, respectively). A combination of native parameters (T1, T2, and longitudinal strain) significantly increased the diagnostic performance of CMR compared with LLC without need of contrast media application (0.99 vs. 0.90; P = 0.008).
  
  
  CONCLUSIONS
  In patients suspected of having acute myocarditis, diagnostic performance of CMR can be improved by implementation of quantitative CMR parameters. Especially, native mapping techniques have the potential to replace current LLC. CLINICALTRIALS.
  NCT02299856.
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Luetkens
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Rami
authors.initials: R
authors.lastname: Homsi
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Alois M
authors.initials: AM
authors.lastname: Sprinkart
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany Department of Radiology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Doerner
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Dabir
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Kuetting
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Block
authors.affiliation: Department of Cardiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Andrié
authors.affiliation: Philips Research, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stehning
authors.affiliation: Department of Medical Biometry, Informatics, and Epidemiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany Philips Research, Hamburg, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Gieseke
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Thomas
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Schild
authors.affiliation: Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany cp@naehle.net.
authors.forename: Claas P
authors.initials: CP
authors.lastname: Naehle
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D055424:Cardiac-Gated Imaging Techniques; D016022:Case-Control Studies; D003287:Contrast Media; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology; D009942:Organometallic Compounds; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Diagnosis; Inflammation; Magnetic resonance imaging; Mapping; Myocarditis