title: Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis: The MyoRacer-Trial.
abstract: BACKGROUND
  Data suggest that T1 and T2 mapping have excellent diagnostic accuracy in patients with suspected myocarditis. However, the true diagnostic performance of comprehensive cardiac magnetic resonance (CMR) mapping versus endomyocardial biopsy (EMB) has not been determined.
  
  
  OBJECTIVE
  This study assessed the performance of CMR imaging, including T1 and T2 mapping, compared with EMB in an unselected, consecutive patient cohort with suspected myocarditis. It also examined the potential role of CMR field strength by comparing 1.5-T versus 3.0-T imaging.
  
  
  METHODS
  Patients underwent biventricular EMB, cardiac catheterization (for exclusion of coronary artery disease), and CMR imaging on 1.5- and 3-T scanners. The CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis as well as native T1, calculation of extracellular volume fraction (ECV), and T2 mapping (only on 1.5-T). Patients were divided into 2 groups according to symptom duration (acute: ≤14 days vs. chronic: >14 days).
  
  
  RESULTS
  A total of 129 patients underwent 1.5-T imaging. In patients with acute symptoms, native T1 yielded the best diagnostic performance as defined by the area under the curve (AUC) of receiver-operating curves (0.82) followed by T2 (0.81), ECV (0.75), and LLC (0.56). In patients with chronic symptoms, only T2 mapping yielded an acceptable AUC (0.77). On 3.0-T, AUCs of native T1, ECV, and LLC were comparable to 1.5-T with no significant differences.
  
  
  CONCLUSIONS
  In patients with acute symptoms, mapping techniques provide a useful tool for confirming or rejecting the diagnosis of myocarditis and are superior to the LLC. However, only T2 mapping has acceptable diagnostic performance in patients with chronic symptoms. (Magnetic Resonance Imaging in Myocarditis [MyoRacer]; NCT02177630).
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany. Electronic address: Philipp.Lurz@gmx.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Luecke
authors.affiliation: University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Föhrenbach
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Clara
authors.initials: C
authors.lastname: Frank
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.affiliation: University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Karl-Philipp
authors.initials: KP
authors.lastname: Rommel
authors.affiliation: Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Julia Anna
authors.initials: JA
authors.lastname: Lurz
authors.affiliation: Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.affiliation: Department of Molecular Pathology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University Heart Center Luebeck, University of Schleswig-Holstein, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), Luebeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D004699:Endocardium / Q000473:pathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007150:Immunohistochemistry; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D017063:Outcome Assessment, Health Care; D062072:Patient Acuity; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: endomyocardial biopsy; extracellular volume; mapping; myocardial inflammation