title: Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) is increasingly used to diagnose myocarditis in adults but its use in children is not well-established. We sought to describe the presentation, CMR protocol and findings, and outcomes in a multicenter cohort of children with myocarditis.
  
  
  METHODS
  Thirteen hospitals retrospectively identified patients meeting the following inclusion criteria: 1) diagnosis of myocarditis by the managing physicians, 2) age <21 years, 3) CMR examination within 30 days of presentation, and 4) no congenital heart disease. Clinical data and test results, including CMR findings, were abstracted from the medical record.
  
  
  RESULTS
  For the 143 patients meeting inclusion criteria, the median age was 16.0 years (range, 0.1-20.3) and 139 (97 %) were hospitalized at the time of CMR. The median time from presentation to CMR was 2 days (0-28). The median left ventricular ejection fraction at CMR was 56 % (10-74), with 29 (20 %) below 45 %. The median right ventricular ejection fraction was 54 % (15-72), with 11 (8 %) below 40 %. There was significant variability among centers in the types of tissue characterization techniques employed (p < 0.001). Overall, late gadolinium enhancement (LGE) was used in 100 % of studies, followed by T2-weighted imaging (T2W) in 69 %, first-pass contrast perfusion (FPP) in 48 %, and early gadolinium enhancement (EGE) in 28 %. Abnormalities were most common with LGE (81 %), followed by T2W (74 %), EGE (55 %), and FPP (8 %). The CMR study was interpreted as positive for myocarditis in 117 patients (82 %), negative in 18 (13 %), and equivocal in 7 (5 %), yielding a sensitivity of 82 %. At a median follow-up of 7.1 months (0-87), all patients were alive and 5 had undergone cardiac transplantation. CMR parameters at presentation associated with persistent left ventricular dysfunction were larger left ventricular end-diastolic volume and lower left and right ventricular ejection fraction but not abnormal LGE.
  
  
  CONCLUSIONS
  Despite significant practice variation in imaging protocol among centers, CMR had a high sensitivity for the diagnosis of myocarditis in pediatric patients. Abnormalities were most often seen with LGE followed by T2W, EGE, and FPP. These findings should be useful in designing future prospective studies.
authors.affiliation: Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA. puja.banka@cardio.chboston.org.
authors.forename: Puja
authors.initials: P
authors.lastname: Banka
authors.affiliation: Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA. jdrobinson@luriechildrens.org.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Robinson
authors.affiliation: Mount Sinai Hospital and Icahn School of Medicine, New York, NY, USA. santosh.uppu@mssm.edu.
authors.forename: Santosh C
authors.initials: SC
authors.lastname: Uppu
authors.affiliation: Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA, USA. harrismat@email.chop.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Harris
authors.affiliation: Advocate Children's Hospital, Park Ridge, IL, USA. khasbani@yahoo.com.
authors.forename: Keren
authors.initials: K
authors.lastname: Hasbani
authors.affiliation: Morgan Stanley Children's Hospital of NewYork-Presbyterian and Columbia College of Physicians and Surgeons, New York, NY, USA. wl2269@cumc.columbia.edu.
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Morgan Stanley Children's Hospital of NewYork-Presbyterian and Columbia College of Physicians and Surgeons, New York, NY, USA. mr2306@cumc.columbia.edu.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.affiliation: Deutsches Herzzentrum München, Munich, Germany. fratz@dhm.mhn.de.
authors.forename: Sohrab
authors.initials: S
authors.lastname: Fratz
authors.affiliation: Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY, USA. supr008@gmail.com.
authors.forename: Supriya
authors.initials: S
authors.lastname: Jain
authors.affiliation: Riley Hospital for Children and Indiana University school of Medicine, Indianapolis, IN, USA. tifjohns@iu.edu.
authors.forename: Tiffanie R
authors.initials: TR
authors.lastname: Johnson
authors.affiliation: Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA. samaskat@bcm.edu.
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Maskatia
authors.affiliation: C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA. jimmyl@med.umich.edu.
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lu
authors.affiliation: Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA. msamyn@chw.org.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Samyn
authors.affiliation: Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada. david.patton@albertahealthservices.ca.
authors.forename: David
authors.initials: D
authors.lastname: Patton
authors.affiliation: Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA. Andrew.powell@cardio.chboston.org.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D016027:Heart Transplantation; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D003287:Contrast Media