Cardiac magnetic resonance imaging in dilated cardiomyopathy in adults—towards identification of myocardial inflammation

• Published in: European radiology 2011-05, Vol.21 (5), p.925-935
• Main Authors: Voigt, Antje, Elgeti, Thomas, Durmus, Tahir, Idiz, Merve Ece, Butler, Craig, Beling, Mark, Schilling, Rene, Klingel, Karin, Kandolf, Reinhard, Stangl, Karl, Taupitz, Matthias, Kivelitz, Dietmar, Wagner, Moritz
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Adults; Biopsy; Cardiac; Cardiology; Cardiomyopathy; Cardiomyopathy, Dilated - pathology; Cardiovascular disease; Contrast agents; Coronary vessels; Diagnostic Radiology; Echocardiography - methods; Edema; Edema - pathology; Female; Gadolinium - pharmacology; Heart failure; Humans; Hypertension; Imaging; Inflammation; Internal Medicine; Interventional Radiology; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Musculoskeletal system; Myocarditis; Myocarditis - pathology; Myocardium - pathology; Neuroradiology; Patients; Pericarditis; Radiology; Retrospective Studies; Sarcoidosis; Sensitivity and Specificity; Ultrasound; Vein & artery diseases
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-010-1985-2

Objective To assess active myocardial inflammation by cardiovascular magnetic resonance (CMR) and endomyocardial biopsy (EMB) amongst adult patients with dilated cardiomyopathy (DCM). Methods We evaluated 23 adults with chronic DCM, who had successfully undergone both CMR and EMB within 3.5 ± 2.6 days. EMB was considered the gold standard. CMR assessment of myocardial inflammation used the following parameters as recommended by the recently published “Lake Louise Criteria”: global myocardial oedema, global relative enhancement (RE), and late gadolinium enhancement (LGE). According to “Lake Louise Criteria”, myocardial inflammation was diagnosed if two or more of the three above-mentioned parameters were positive. Results Myocardial inflammation was confirmed by immunohistology in 12 patients (52.2%). Sensitivity, specificity, and diagnostic accuracy of CMR to detect immunohistologically confirmed myocardial inflammation were 75.0%, 72.7%, and 73.9%, respectively. Sensitivity, specificity, and diagnostic accuracy of the individual CMR parameters to detect myocardial inflammation were as follows: global myocardial oedema, 91.7%, 81.8%, and 87.0%, respectively; global RE, 58.3%, 63.6%, and 60.9%, respectively; LGE, 58.3%, 45.4%, and 52.2%, respectively. Conclusion Global myocardial oedema was identified as a promising CMR parameter for assessment of myocardial inflammation in patients with DCM. In these patients, global myocardial oedema yielded superior diagnostic performance compared to “Lake Louise Criteria”.