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Acute Myocarditis Better Evaluated With Cardiac MRI

March 20, 2009
Written by: , Filed in: Interventional Radiology
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Acute Myocarditis Better Evaluated With Cardiac MRI

A recent study designed to evaluate cardiac MRI compared with transthoracic echocardiography (TTE) for diagnosis of acute myocarditis was published in AJR, and has revealed that patients suspected of having acute myocarditis more often demonstrate abnormal regional epicardial-delayed hyperenhancement on cardiac MRI than they demonstrate wall motion abnormality on transthoracic echocardiography.

The Study
32 patients clinically suspected of having acute myocarditis. All patients had both a cardiac MRI and a TTE.

Methodology
Patients were suspected of having acute myocarditis based on a history of chest pain or shortness of breath, elevated troponin levels, and changes on ECG suggesting myocarditis.

Of patients, 78% had a fever, and 60% had a recent upper respiratory infection.

The cardiac MRI had functional evaluation of the left ventricle performed using standard software. Functional evaluation of the left ventricle was performed using a steady-state free precession in the short-axis oblique plane.

Evaluation of delayed hyperenhancement was performed 10 to 20 minutes following gadolinium administration. A T1-weighted 2-dimensional gradient-echo inversion recovery sequence was adjusted in each patient to null the myocardium.

The pattern of myocardial-delayed hyperenhancement was characterized, and the extent of left ventricular wall involvement was measured.

TTEs were performed in the left lateral position, and myocardial segments were characterized as having normal wall motion, hypokinetic, akinetic, or dyskinetic.

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review

Results of the Study
Cardiac MRI demonstrated regional abnormality rather than global involvement. Epicardial-delayed hyperenhancement was seen in 21 patients (91%), whereas TTE demonstrated regional wall motion abnormality in 8 (35%; P <0.001).

On cardiac MRI, the abnormal delayed enhancement was present most often in the inferior and inferolateral segments in the mid-ventricular portion (segments 4 and 10 and segments 5 and 11).

On TTE, the distribution of wall motion abnormality matched the distribution of abnormal delayed enhancement on cardiac MRI in 6 of 8 patients with abnormal echocardiograms.

No correlation was present between serum cardiac marker levels and degree of myocardial involvement seen on cardiac MRI or TTE.

Conclusions
Cardiac MRI may have a greater impact than TTE in substantiating the presence of acute myocarditis, and assessing the amount of myocardial involvement. This may prevent the need for more invasive procedures such as invasive angiography or endomyocardial biopsy.

Reviewer’s Comments

The authors have demonstrated that cardiac MRI can be very helpful in trying to determine if a patient has acute myocarditis.

Author: Vineet R. Jain, MD

Reference:
Goitein O, Matetzky S, et al. Acute Myocarditis: Noninvasive Evaluation With Cardiac MRI and Transthoracic Echocardiography. AJR; 2009;192 (January): 254-258

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review
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