PMID- 24011774 OWN - NLM STAT- MEDLINE DCOM- 20140602 LR - 20220318 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 6 IP - 10 DP - 2013 Oct TI - T(1) mapping for the diagnosis of acute myocarditis using CMR: comparison to T2-weighted and late gadolinium enhanced imaging. PG - 1048-1058 LID - S1936-878X(13)00539-1 [pii] LID - 10.1016/j.jcmg.2013.03.008 [doi] AB - OBJECTIVES: This study sought to test the diagnostic performance of native T1 mapping in acute myocarditis compared with cardiac magnetic resonance (CMR) techniques such as dark-blood T2-weighted (T2W)-CMR, bright-blood T2W-CMR, and late gadolinium enhancement (LGE) imaging. BACKGROUND: The diagnosis of acute myocarditis on CMR often requires multiple techniques, including T2W, early gadolinium enhancement, and LGE imaging. Novel techniques such as T1 mapping and bright-blood T2W-CMR are also sensitive to changes in free water content. We hypothesized that these techniques can serve as new and potentially superior diagnostic criteria for myocarditis. METHODS: We investigated 50 patients with suspected acute myocarditis (age 42 +/- 16 years; 22% women) and 45 controls (age 42 +/- 14 years; 22% women). CMR at 1.5-T (median 3 days from presentation) included: 1) dark-blood T2W-CMR (short-tau inversion recovery); 2) bright-blood T2W-CMR (acquisition for cardiac unified T2 edema); 3) native T1 mapping (shortened modified look-locker inversion recovery); and 4) LGE. Image analysis included: 1) global T2 signal intensity ratio of myocardium compared with skeletal muscle; 2) myocardial T1 relaxation times; and 3) areas of LGE. RESULTS: Compared with controls, patients had significantly higher global T2 signal intensity ratios by dark-blood T2W-CMR (1.73 +/- 0.27 vs. 1.56 +/- 0.15, p < 0.01), bright-blood T2W-CMR (2.02 +/- 0.33 vs. 1.84 +/- 0.17, p < 0.01), and mean myocardial T1 (1,010 +/- 65 ms vs. 941 +/- 18 ms, p < 0.01). Receiver-operating characteristic analysis showed clear differences in diagnostic performance. The areas under the curve for each method were: T1 mapping (0.95), LGE (0.96), dark-blood T2 (0.78), and bright-blood T2 (0.76). A T1 cutoff of 990 ms had a sensitivity, specificity, and diagnostic accuracy of 90%, 91%, and 91%, respectively. CONCLUSIONS: Native T1 mapping as a novel criterion for the detection of acute myocarditis showed excellent and superior diagnostic performance compared with T2W-CMR. It also has a higher sensitivity compared with T2W and LGE techniques, which may be especially useful in detecting subtle focal disease and when gadolinium contrast imaging is not feasible. CI - Copyright (c) 2013. Published by Elsevier Inc. FAU - Ferreira, Vanessa M AU - Ferreira VM AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Piechnik, Stefan K AU - Piechnik SK AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Dall'Armellina, Erica AU - Dall'Armellina E AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Karamitsos, Theodoros D AU - Karamitsos TD AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Francis, Jane M AU - Francis JM AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Ntusi, Ntobeko AU - Ntusi N AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Holloway, Cameron AU - Holloway C AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Choudhury, Robin P AU - Choudhury RP AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Kardos, Attila AU - Kardos A AD - Department of Cardiology, Milton Keynes NHS Hospital Foundation Trust, Milton Keynes, United Kingdom. FAU - Robson, Matthew D AU - Robson MD AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. FAU - Friedrich, Matthias G AU - Friedrich MG AD - Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada; Department of Cardiology, Universite de Montreal, Montreal, Quebec, Canada. FAU - Neubauer, Stefan AU - Neubauer S AD - Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: stefan.neubauer@cardiov.ox.ac.uk. LA - eng GR - 088291/Wellcome Trust/United Kingdom GR - 090532/Wellcome Trust/United Kingdom GR - G0700796/MRC_/Medical Research Council/United Kingdom PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20130904 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - 84F6U3J2R6 (gadodiamide) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - JACC Cardiovasc Imaging. 2013 Oct;6(10):1059-61. PMID: 24135320 MH - Acute Disease MH - Adult MH - Case-Control Studies MH - *Contrast Media MH - Edema, Cardiac/diagnosis MH - England MH - Female MH - *Gadolinium DTPA MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocarditis/*diagnosis MH - Predictive Value of Tests MH - Prospective Studies OTO - NOTNLM OT - AUC OT - CMR OT - EGE OT - EMB OT - LGE OT - PPV OT - ROC OT - SI OT - STIR OT - ShMOLLI OT - T(1) mapping OT - T(2)-weighted OT - T(2)-weighted CMR OT - T2W OT - area under the curve OT - cardiac magnetic resonance OT - early gadolinium enhancement OT - endomyocardial biopsy OT - late gadolinium enhancement OT - myocarditis OT - positive predictive value OT - receiver-operating characteristic OT - short-tau inversion recovery OT - shortened modified look-locker inversion recovery OT - signal intensity EDAT- 2013/09/10 06:00 MHDA- 2014/06/03 06:00 CRDT- 2013/09/10 06:00 PHST- 2013/03/06 00:00 [received] PHST- 2013/03/29 00:00 [accepted] PHST- 2013/09/10 06:00 [entrez] PHST- 2013/09/10 06:00 [pubmed] PHST- 2014/06/03 06:00 [medline] AID - S1936-878X(13)00539-1 [pii] AID - 10.1016/j.jcmg.2013.03.008 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2013 Oct;6(10):1048-1058. doi: 10.1016/j.jcmg.2013.03.008. Epub 2013 Sep 4.