title: Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis.
abstract: Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease.
  
  
  CONCLUSIONS
  • CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. • Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. • T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. • A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.
authors.affiliation: IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esposito
authors.affiliation: Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena 324, 00161, Rome, Italy. Marco.Francone@uniroma1.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.affiliation: Radiologia Università Torino, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Faletti
authors.affiliation: Radiologia OC S. Chiara Trento, Trento, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Centonze
authors.affiliation: Department of Radiology, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, V.le Regina Elena 324, 00161, Rome, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.affiliation: ASL Napoli 1, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Rosa
authors.affiliation: Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Cesare
authors.affiliation: Palermo University, Palermo, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: La Grutta
authors.affiliation: Azienda Ospedaliera-Universitaria Policlinico di Modena, Modena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.affiliation: Policlinico S. Orsola Bologna, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lovato
authors.affiliation: Department of Radiology, Montreal Heart Institute, Universitè de Montreal, Montreal, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Università Cattolica Roma, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marano
authors.affiliation: Palermo University, Palermo, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.affiliation: IRCCS Centro Cardiologico Monzino, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Università Cattolica Roma, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Natale
authors.affiliation: IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
keywords: Acute myocarditis; Cardiac magnetic resonance; Lake Louise criteria; T1 mapping