Myocardial Inflammation-Are We There Yet?

Area of Science:

• Cardiology
• Radiology
• Immunology

Background:

• Inflammatory heart disease, including infectious myocarditis and systemic disorders like lupus and rheumatoid arthritis, significantly impacts patient prognosis, leading to arrhythmias and heart failure.
• Current diagnostic methods, primarily endomyocardial biopsy (EMB), are invasive and limited by sensitivity and specificity issues due to sampling errors.
• There is a critical need for non-invasive techniques to accurately assess myocardial inflammation and its progression over time.

Approach:

• This review discusses various non-invasive cardiac magnetic resonance (CMR) imaging techniques for evaluating inflammatory myocardial disease.
• Methods covered include early gadolinium enhancement (EGE), T2-weighted imaging, and late gadolinium enhancement (LGE).
• Advanced techniques such as T1 mapping (pre- and post-contrast) and T2 mapping, alongside hybrid PET/MRI, are also explored.

Key Points:

• Cardiac magnetic resonance (CMR) provides a non-invasive means to detect and monitor myocardial inflammation.
• CMR techniques like EGE, T2-weighted imaging, LGE, and mapping sequences offer complementary information on myocardial tissue characteristics.
• Hybrid PET/MRI combines metabolic and structural imaging for comprehensive assessment.

Conclusions:

• Non-invasive CMR imaging is essential for diagnosing and managing inflammatory heart disease, offering an alternative to EMB.
• Advanced CMR techniques improve the detection and characterization of myocardial inflammation.
• These imaging modalities are crucial for understanding disease extent and guiding therapeutic strategies.