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Published on: February 16, 2016
Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion
Jean-Pierre Laissy1, Fabien Hyafil, Laurent J Feldman
1Department of Radiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris 18, France. jean-pierre.laissy@bch.ap-hop-paris.fr
Purpose:
To prospectively determine whether early first-pass perfusion and delayed-enhancement magnetic resonance (MR) imaging sequences can enable differentiation of acute myocardial infarction (AMI) from myocarditis in patients with acute chest pain.
Materials And Methods:
All examinations were performed according to guidelines of the institutional board on medical ethics and clinical investigation and after informed patient consent was obtained. Fifty-five patients with a clinical presentation suggestive but not typical of AMI were examined. At final diagnosis, 31 patients had AMI and 24 had myocarditis. At-rest MR imaging was performed and included first-pass perfusion and delayed-enhancement sequences. Three independent observers read each image data set separately and then in consensus. The main abnormalities included first-pass perfusion defects and delayed highly enhancing areas. The numbers and distributions of involved segments and the transmural extents and the shapes of the highly enhancing areas were noted. For comparisons between the AMI and myocarditis patient groups, the chi2 test was used to assess the locations of the abnormalities and the Mann-Whitney U test was used to assess the numbers of involved segments. The final diagnoses were obtained with coronary angiography as the reference standard for the AMI group and on the basis of normal coronary angiographic findings and the spontaneous resolution of clinical symptoms and wall motion abnormalities for the myocarditis group.
Results:
MR imaging patterns were significantly different between the two cardiac disease groups (P < .05). All the patients with AMI had a segmental early subendocardial defect, with corresponding segmental subendocardial or transmural delayed high enhancement in a predominantly anteroseptal or inferior vascular distribution in 28 patients. All patients with AMI had stenosis of at least the infarct-affected coronary artery. All but one of the patients with myocarditis had no early defect and focal or diffuse nonsegmental nonsubendocardial delayed enhancement predominantly in an inferolateral location.
Conclusion:
Use of combined early- and late-perfusion MR imaging sequences helps to distinguish AMI from myocarditis.
Insights
Magnetic resonance imaging (MRI) using early and delayed sequences can differentiate acute myocardial infarction (AMI) from myocarditis. This imaging technique aids in distinguishing these two cardiac conditions in patients presenting with chest pain.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Acute chest pain is a common clinical presentation requiring accurate diagnosis.
- Differentiating acute myocardial infarction (AMI) from myocarditis is crucial for appropriate patient management.
- Magnetic resonance (MR) imaging offers advanced visualization of cardiac tissue.
Purpose of the Study:
- To prospectively evaluate the efficacy of early first-pass perfusion and delayed-enhancement MR imaging in distinguishing AMI from myocarditis.
- To assess the diagnostic performance of specific MR imaging patterns in patients with acute chest pain.
Main Methods:
- Fifty-five patients with suspected AMI or myocarditis underwent at-rest MR imaging, including first-pass perfusion and delayed-enhancement sequences.
- Image analysis focused on perfusion defects and delayed enhancement patterns, including location, extent, and transmurality.
- Statistical analysis (chi-squared test, Mann-Whitney U test) compared imaging findings between AMI and myocarditis groups.
Main Results:
- MR imaging patterns significantly differed between AMI and myocarditis groups (P < .05).
- Patients with AMI typically showed segmental subendocardial defects with corresponding enhancement in a vascular distribution.
- Myocarditis patients often presented with nonsegmental, non-subendocardial enhancement, predominantly in the inferolateral wall.
Conclusions:
- Combined early- and late-perfusion MR imaging sequences are effective in differentiating acute myocardial infarction from myocarditis.
- This MR imaging approach aids in the diagnosis of acute cardiac conditions presenting as chest pain.
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