Usefulness of Subepicardial Hyperemia on Contrast-Enhanced First-Pass Magnetic Resonance Perfusion Imaging for Diagnosis of Acute Myocarditis.
Hyperemia is a major criterion for the diagnosis of acute myocarditis on cardiac magnetic resonance imaging but its assessment is challenging and time consuming. We evaluated the usefulness of the contrast-enhanced first-pass perfusion (FPP) on magnetic resonance imaging for detecting subepicardial hyperemia in acute myocarditis. Forty-seven consecutive patients (mean age: 42 ± 15.6 years; 35 men) with a definite diagnosis of acute myocarditis according to the state-of-the-art guidelines were included and compared with 16 control subjects. FPP was evaluated by 2 blinded observers and compared with the reference late gadolinium enhancement. Detection of hyperemia was performed on both qualitative and quantitative methods. Relative increased signal intensity (SI) in the subepicardial hyperemic layer was measured with SI ratio (SI of the subepicardial layer/SI of the immediately adjacent subendocardial layer). Twenty-four patients (51%) with acute myocarditis exhibited subepicardial hyperemia, detected with a good interobserver reproducibility (kappa coefficient: 0.75). The SI in the myocardium of myocarditis patients was increased compared with controls (1.08 ± 0.03 vs 0.945 ± 0.04, p = 0.03) and the SI in myocarditis patients with hyperemia compared with those without hyperemia (1.22 ± 0.04 vs 0.94 ± 0.04, p <0.0001). Sensitivity, specificity, positive predictive, and negative predictive values of FPP for detecting hyperemia were 85%, 94%, 85%, and 93%, respectively. In conclusion, contrast-enhanced first-pass magnetic resonance imaging is a fast and useful method for assessing myocardial hyperemia in patients with acute myocarditis.
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Samuel
S
Zarka
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Claire
C
Bouleti
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Dimitri
D
Arangalage
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Houzefa
H
Chopra
Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Sylvie
S
Chillon
Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Marie-Cécile
MC
Henry-Feugeas
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Jérémie
J
Abtan
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Jean-Michel
JM
Juliard
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Bernard
B
Iung
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; Paris-Diderot University, DHU FIRE, Paris, France.
Alec
A
Vahanian
Paris-Diderot University, DHU FIRE, Paris, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
Jean-Pierre
JP
Laissy
Paris-Diderot University, DHU FIRE, Paris, France; Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148 Bichat Hospital, Paris, France. Electronic address: phalla.ou@aphp.fr.
Phalla
P
Ou
D000208:Acute Disease; D000328:Adult; D003287:Contrast Media; D005260:Female; D006571:Heterocyclic Compounds; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D009205:Myocarditis / Q000000981:diagnostic imaging*; D009942:Organometallic Compounds; D010496:Pericardium / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies
D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate