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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
T1 Mapping for the diagnosis of acute myocarditis using CMR: Comparison to T2-Weighted and late gadolinium enhanced imaging
JACC: Cardiovascular Imaging, Volume 6, No. 10, Year 2013
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Description
Objectives This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. Background The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. Methods We investigated 50 patients with suspected acute myocarditis (age 42 ± 16 years; 22% women) and 45 controls (age 42 ± 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. Results Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 ± 0.27 vs. 1.56 ± 0.15, p < 0.01), bright-blood T2W-CMR (2.02 ± 0.33 vs. 1.84 ± 0.17, p < 0.01), and mean myocardial T1 (1,010 ± 65 ms vs. 941 ± 18 ms, p < 0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively. Conclusions Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible. © 2013 by the American College of Cardiology Foundation.
Authors & Co-Authors
Ferreira, Vanessa M.
United Kingdom, Oxford
John Radcliffe Hospital
Piechnik, Stefan Kazimierz
United Kingdom, Oxford
John Radcliffe Hospital
Karamitsos, Theodoros D.
United Kingdom, Oxford
John Radcliffe Hospital
Francis, Jane M.
United Kingdom, Oxford
John Radcliffe Hospital
Ntusi, Ntobeko A.B.
United Kingdom, Oxford
John Radcliffe Hospital
Holloway, Cameron J.
United Kingdom, Oxford
John Radcliffe Hospital
Kardos, Attila
United Kingdom, Milton Keynes
Milton Keynes University Hospital Nhs Foundation Trust
Robson, Matthew D.
United Kingdom, Oxford
John Radcliffe Hospital
Friedrich, Matthias G.
Canada, Calgary
Libin Cardiovascular Institute
Canada, Montreal
University of Montreal
Neubauer, Stefan
United Kingdom, Oxford
John Radcliffe Hospital
Statistics
Citations: 340
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1016/j.jcmg.2013.03.008
ISSN:
18767591
Research Areas
Environmental
Noncommunicable Diseases
Participants Gender
Female