Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study

Journal of Cardiovascular Magnetic Resonance

Research

Keren Hasbani¹  David Patton²  Joshua D. Robinson³  Andrew J. Powell⁴  Puja Banka⁴  Jimmy C. Lu⁵  Matthew A. Harris⁶  Margaret M. Samyn⁷  Sohrab Fratz⁸  Supriya Jain⁹  Wyman W. Lai^1,10  Marc E. Richmond^1,10  Santosh C. Uppu^1,11  Tiffanie R. Johnson^1,12  Shiraz A. Maskatia^1,13 

[1] Advocate Children’s Hospital, Park Ridge, IL, USA;Alberta Children’s Hospital and University of Calgary, Calgary, AB, Canada;Ann & Robert H Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA;Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave, 02115, Boston, MA, USA;C. S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI, USA;Children’s Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA, USA;Children’s Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA;Deutsches Herzzentrum München, Munich, Germany;Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY, USA;Morgan Stanley Children’s Hospital of NewYork-Presbyterian and Columbia College of Physicians and Surgeons, New York, NY, USA;Mount Sinai Hospital and Icahn School of Medicine, New York, NY, USA;Riley Hospital for Children and Indiana University school of Medicine, Indianapolis, IN, USA;Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA;

关键词: Cardiovascular magnetic resonance;    Myocarditis;    Pediatrics;    Late gadolinium enhancement;    Early gadolinium enhancement;    T2-weighted imaging;   

DOI  :  10.1186/s12968-015-0201-6

 received in 2015-05-14, accepted in 2015-11-02,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCardiovascular 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.MethodsThirteen 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.ResultsFor 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.ConclusionsDespite 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.

【 授权许可】

CC BY   
© Banka et al. 2015