Diagnostic Performance of CMR Imaging Compared With EMB in Patients With Suspected Myocarditis

JACC-CARDIOVASCULAR IMAGING

卷:5

Article

Lurz, Philipp¹  Eitel, Ingo¹  Adam, Julia²  Steiner, Julia²  Grothoff, Matthias²  Desch, Steffen¹  Fuernau, Georg¹  de Waha, Suzanne¹  Sareban, Mahdi¹  Luecke, Christian²  Klingel, Karin³  Kandolf, Reinhard³  Schuler, Gerhard¹  Gutberlet, Matthias²  Thiele, Holger¹ 

[1] Univ Leipzig, Ctr Heart, Dept Internal Med Cardiol, D-04289 Leipzig, Germany

[2] Univ Leipzig, Ctr Heart, Dept Diagnost & Intervent Radiol, D-04289 Leipzig, Germany

[3] Univ Tubingen, Dept Mol Pathol, Tubingen, Germany

关键词: cardiac magnetic resonance;    endomyocardial biopsy;    myocardial inflammation;    myocarditis;   

DOI  :  10.1016/j.jcmg.2011.11.022

来源: Elsevier

【 摘 要 】

OBJECTIVES The goal of this study was to assess the diagnostic performance of cardiac magnetic resonance (CMR) compared with endomyocardial biopsy in patients with suspected acute myocarditis (AMC) and chronic myocarditis (CMC). BACKGROUND Several studies have reported an encouraging diagnostic performance of CMR in myocarditis. However, the comparison of CMR with clinical data only and the use of preselected patient populations are important limitations of the majority of these reports. METHODS One hundred thirty-two consecutive patients with suspected AMC (defined by symptoms <14 days; n = 70) and CMC (defined by symptoms >14 days; n = 62) were included. Patients underwent cardiac catheterization with left ventricular endomyocardial biopsy and CMR, including T-2-weighted imaging for assessment of edema, T-1-weighted imaging before and after contrast administration for evaluation of hyperemia, and assessment of late gadolinium enhancement. CMR results were considered to be consistent with the diagnosis of myocarditis if 2 of 3 CMR techniques were positive. RESULTS Within the total population, myocarditis was the most common diagnosis on endomyocardial biopsy analysis (62.9%). Viral genomes were detected in 30.3% (40 of 132) of patients within the total patient population and significantly more often in patients with AMC than CMC (40.0% vs. 19.4%; p = 0.013). For the overall cohort of patients with either suspected AMC or CMC, the diagnostic sensitivity, specificity, and accuracy of CMR were 76%, 54%, and 68%, respectively. The best diagnostic performance was observed in patients with suspected AMC (sensitivity, 81%; specificity, 71%; and accuracy, 79%). In contrast, diagnostic performance of CMR in suspected CMC was found to be unsatisfactory (sensitivity, 63%; specificity, 40%; and accuracy, 52%). CONCLUSIONS The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management. (J Am Coll Cardiol Img 2012;5:513-24) (C) 2012 by the American College of Cardiology Foundation

【 授权许可】

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