Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations

This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use para...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2018-12, Vol.72 (24), p.3158-3176
Main Authors: Ferreira, Vanessa M, Schulz-Menger, Jeanette, Holmvang, Godtfred, Kramer, Christopher M, Carbone, Iacopo, Sechtem, Udo, Kindermann, Ingrid, Gutberlet, Matthias, Cooper, Leslie T, Liu, Peter, Friedrich, Matthias G
Format: Article
Language:English
Subjects:
Accuracy
Angina pectoris
Biopsy
Cardiology
Cardiomyopathy
Criteria
Diagnostic systems
Edema
Gadolinium
Gangrene
Heart failure
Inflammation
Localization
Magnetic resonance
Mapping
Musculoskeletal system
Pain
Relaxation time
Resonance
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Summary:This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2018.09.072