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Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis

Colin G Stirrat1, Shirjel R Alam1, Thomas J MacGillivray2,3

  • 1British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.

Heart (British Cardiac Society)
|October 8, 2017
PubMed
Abstract

Insights

Ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced MRI did not improve acute myocarditis diagnosis. USPIO-enhanced MRI did not provide additional information beyond standard MRI techniques for assessing myocardial inflammation.

Area of Science:

  • Cardiovascular Imaging
  • Magnetic Resonance Imaging

Background:

  • Ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect tissue-resident macrophage activity and cellular inflammation.
  • Acute myocarditis diagnosis and management can benefit from non-invasive imaging techniques.

Purpose of the Study:

  • To investigate if USPIO-enhanced MRI improves the diagnosis and management of acute myocarditis.
  • To assess the role of tissue-resident macrophages in myocardial inflammation using USPIO-enhanced MRI.

Main Methods:

  • 14 patients with suspected acute myocarditis and 10 healthy volunteers underwent 3T MRI, including T2, T2*, and late gadolinium enhancement (LGE).
  • T2* imaging was performed after USPIO (ferumoxytol) infusion at baseline and 3 months to assess myocardial edema and USPIO enhancement.
  • Myocardial edema and USPIO enhancement were quantified within LGE regions and the entire myocardium.

Main Results:

  • Myocarditis was confirmed in 9 of 14 patients. Patients showed greater myocardial edema in LGE regions compared to volunteers (T2 value, 57.1±5.3 vs 46.7±1.6 ms, p<0.0001).
  • No significant difference in USPIO enhancement was observed between patients and volunteers, even in LGE regions (change in R2*, 35.0±15.0 vs 37.2±9.6 s⁻¹, p>0.05).
  • After 3 months, patients showed reduced LGE volume, decreased edema within LGE regions, and improved ejection fraction (p<0.05 for all).

Conclusions:

  • USPIO-enhanced MRI does not provide additional clinically relevant information compared to LGE and T2 mapping MRI in acute myocarditis.
  • Tissue-resident macrophages may not significantly contribute to myocardial inflammation in acute myocarditis.
  • Standard MRI techniques remain valuable for assessing myocardial inflammation and disease progression in acute myocarditis.
Keywords:
MRIUSPIO.cardiacinflammationmyocarditis

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