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Performance of native and contrast-enhanced T1 mapping to detect myocardial damage in patients with suspected myocarditis: a head-to-head comparison of different cardiovascular magnetic resonance techniques

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Abstract

Myocardial T1 mapping is a novel technique that has proven to be superior to standard imaging for differentiation between healthy individuals in acute myocarditis. Aim of this study was comparison of T1 mapping with a clinical biomarker. We retrospectively investigated 171 patients undergoing cardiovascular magnetic resonance (CMR) examination with suspected myocarditis by performing native and contrast enhanced T1-mapping. Additionally, T2w and T1w images and late gadolinium enhancement sequences (LGE) were utilized for myocardial evaluation; Lake Louise Criteria comprise T1w, T2w and LGE imaging in a score. Reference for positive myocarditis diagnosis was a ten-fold increase of troponin level above normal (0.14 ng/ml). Native T1 and extracellular volume (ECV) showed good association with relevant troponin elevations. Area under the curve (AUC) was 81% (p = 0.0001) for native T1 with an optimal threshold of 979 ms and 86% (p < 0.0001) for ECV with an optimal cutoff of 32.4%. AUC for T2w imaging (T2-signal intensity ratio to skeletal muscle) was 77% (p = 0.0003). AUC for T2w imaging (T2-signal intensity compared to remote myocardium) was 69% (p = 0.012). Additionally, we found positive correlation for native T1 and ECV with the Lake Louise Criteria (r = 0.44, p = 0.0001 for native T1 and r = 0.45, p = 0.0001 for ECV). Correlated to troponin as biomarker, ECV and native T1 mapping perform at least equally well in comparison to established CMR-techniques LGE, T2w imaging and the combined Lake Louise Criteria in detecting acute myocardial damage. Normal ECV values rule out myocardial damage with very high certainty. T1 mapping qualifies for further prospective evaluations to evolve as a separate biomarker.

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Authors and Affiliations

  1. Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany

    Jonathan Nadjiri, Hanna Nieberler, Eva Hendrich, Albrecht Will, Stefan Martinoff & Martin Hadamitzky

  2. Siemens Healthcare GmbH, Erlangen, Germany

    Andreas Greiser

  3. Department of Diagnostic and Interventional Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany

    Jonathan Nadjiri

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  1. Jonathan Nadjiri
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  2. Hanna Nieberler
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  4. Andreas Greiser
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  7. Martin Hadamitzky
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Correspondence to Jonathan Nadjiri.

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Conflict of interest

Andreas Greiser is a full-time employee of Siemens Healthcare GmbH. The other authors have nothing to disclose. This is an investigator-driven study; there is no involvement from outside the departments.

Disclosures

Andreas Greiser is a full-time employee of Siemens Healthcare. The other authors have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study design was approved by the local ethics committee.

Informed consent

This is a retrospective study; all patients underwent clinically indicated CMR examination. All personal details were anonymized for evaluation and publication. Informed consent was waived by the local ethics committee.

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Nadjiri, J., Nieberler, H., Hendrich, E. et al. Performance of native and contrast-enhanced T1 mapping to detect myocardial damage in patients with suspected myocarditis: a head-to-head comparison of different cardiovascular magnetic resonance techniques. Int J Cardiovasc Imaging 33, 539–547 (2017). https://doi.org/10.1007/s10554-016-1029-3

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  • DOI: https://doi.org/10.1007/s10554-016-1029-3

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