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MR delayed enhancement imaging findings in suspected acute myocarditis

Gérald Gahide1, D Bertrand, F Roubille

  • 1Radiologie Centrale - Pôle Cardiovasculaire et Thoracique, CHU de Montpellier, Montpellier, France. geraldgahide@hotmail.com

European Radiology
|August 7, 2009
PubMed

Insights

Routine delayed enhancement imaging in suspected acute myocarditis significantly impacts diagnosis. This cardiac MRI technique confirms myocarditis in over half of patients and corrects misdiagnosed myocardial infarction in nearly 17%.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Clinical Medicine

Background:

  • Acute myocarditis diagnosis can be challenging.
  • Delayed enhancement imaging is a key component of cardiac MRI protocols.

Purpose of the Study:

  • To prospectively evaluate the clinical significance of routine delayed enhancement imaging in suspected acute myocarditis.
  • To assess how delayed enhancement imaging influences diagnostic accuracy and patient management.

Main Methods:

  • A prospective, two-center study involving 60 patients with suspected acute myocarditis.
  • Cardiac MRI protocol included cine sequences and delayed enhancement imaging post-Gd-DTPA administration.
  • Image analysis focused on patterns of delayed enhancement, particularly subendocardial involvement.

Main Results:

  • Delayed enhancement patterns consistent with acute myocarditis (sparing subendocardium) were observed in 51.6% of patients.
  • Patterns indicative of acute myocardial infarction (subendocardial involvement with irregular margins) were found in 16.7% of patients.
  • 31.7% of patients showed normal delayed enhancement imaging findings.

Conclusions:

  • Routine delayed enhancement imaging is crucial for diagnosing acute myocarditis, reinforcing the diagnosis in over half of cases.
  • This imaging technique effectively differentiates acute myocarditis from acute myocardial infarction, correcting misdiagnoses in 16.7% of patients.
  • Delayed enhancement imaging provides vital clinical information, improving diagnostic confidence and potentially guiding treatment decisions in suspected myocarditis.

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