title: Assessment of edema using STIR+ via 3D cardiovascular magnetic resonance imaging in patients with suspected myocarditis.
abstract: OBJECTIVE
  To evaluate three-dimensional T2-weighted fast spin echo triple inversion recovery sequences (STIR+) for the diagnosis of myocardial edema in patients with suspected early myocarditis after respiratory or gastrointestinal tract viral infection and at follow-up.
  
  
  METHODS
  We prospectively examined 28 patients with suspected myocarditis and 37 controls matched for gender and age. An ECG-triggered STIR+ was used to cover the entire left ventricle in short-axis images with 10-mm slice thickness and no interslice gap. The global signal intensity ratio (heart muscle in relation to skeletal muscle) was calculated (global STIR+ ratio) to evaluate edema. All patients had repeat examinations at follow-up (mean interval 4.9 months, 1-12 months).
  
  
  RESULTS
  The mean global STIR+ ratio was 2.15 ± 0.4 in the initial examination of patients as compared to 1.78 ± 0.3 in controls (p < 0.0001) and 1.89 ± 0.3 in patients at follow-up (p = 0.0001 vs. first visit). Left ventricular ejection fraction did not differ between patients and controls at baseline and at follow-up.
  
  
  CONCLUSIONS
  We could identify a significantly higher global STIR+ ratio in patients with suspected myocarditis compared to controls, and a dynamic change during follow-up. The global STIR+ ratio may, therefore, be useful for the diagnosis of myocarditis and should be further explored.
authors.affiliation: Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany. info@praxis-jeserich.de.|Medical Practice, Cardiology and Angiology, Koenigstr. 39, 90402, Nuernberg, Germany. info@praxis-jeserich.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Jeserich
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor 68, 1122, Budapest, Hungary.
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Institute for Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Str.26, 79104, Freiburg, Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Schlosser
authors.affiliation: Medical Practice, Cardiology and Angiology, Koenigstr. 39, 90402, Nuernberg, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Kimmel
authors.affiliation: Department of Health Sciences and Sports Medicine, Universitiy of Physical Education, Alkotás str. 44, Budapest, 1123, Hungary.
authors.forename: Gabor
authors.initials: G
authors.lastname: Pavlik
authors.affiliation: Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
mesh_terms: D000465:Algorithms; D057791:Cardiac Imaging Techniques / Q000379:methods*; D004489:Edema, Cardiac / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
keywords: Cardiovascular magnetic resonance imaging; Late gadolinium enhancement; Left ventricular function; Modified three-dimensional T2-weighted fast spin echo triple inversion recovery sequence; Myocarditis; STIR+