Quantitative Assessment of Late Gadolinium Enhancement and Edema at Cardiac Magnetic Resonance in Low-Risk Myocarditis Patients

• Published in: Tomography (Ann Arbor) Vol. 8; no. 2; pp. 974 - 984
• Main Authors: Monti, Caterina Beatrice, Secchi, Francesco, Alì, Marco, Carbone, Francesco Saverio, Bonomo, Luca, Capra, Davide, Mobini, Nazanin, Di Leo, Giovanni, Sardanelli, Francesco
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 01-04-2022; MDPI AG
• Subjects: Contrast Media; edema; Edema - diagnostic imaging; Gadolinium; Humans; magnetic resonance imaging; Magnetic Resonance Spectroscopy; myocarditis; Myocarditis - diagnostic imaging; Myocarditis - pathology; Retrospective Studies; magnetic resonance imaging; edema; myocarditis; gadolinium
• ISSN: 2379-139X; 2379-1381; 2379-139X
• DOI: 10.3390/tomography8020078

In this study, we aimed to quantify LGE and edema at short-tau inversion recovery sequences on cardiac magnetic resonance (CMR) in patients with myocarditis. We retrospectively evaluated CMR examinations performed during the acute phase and at follow-up. Forty-seven patients were eligible for retrospective LGE assessment, and, among them, twenty-five patients were eligible for edema evaluation. Both groups were paired with age- and sex-matched controls. The median left ventricle LGE was 6.4% (interquartile range 5.0−9.2%) at the acute phase, 4.4% (3.3−7.2%) at follow-up, and 4.3% (3.0−5.3%) in controls, the acute phase being higher than both follow-up and controls (p < 0.001 for both), while follow-up and controls did not differ (p = 0.139). An optimal threshold of 5.0% was obtained for LGE with 87% sensitivity and 48% specificity; the positive likelihood ratio (LR) was 1.67, and the negative LR was 0.27. Edema was 12.8% (9.4−18.1%) at the acute phase, 7.3% (5.5−8.8%) at follow-up, and 6.7% (5.6−8.6%) in controls, the acute phase being higher than both follow-up and controls (both p < 0.001), while follow-up and controls did not differ (p = 0.900). An optimal threshold of 9.5% was obtained for edema with a sensitivity of 76% and a specificity of 88%; the positive LR was 6.33, and the negative LR was 0.27. LGE and edema thresholds are useful in cases of suspected mild myocarditis.