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MRI of Acute Myocarditis^*

A Comprehensive Approach Based on Various Imaging Sequences

^* From the Departments of Radiology (Drs. Laissy, Messin, and Schouman-Claeys) and Cardiology (Drs. Varenne, Iung, Karila-Cohen, and Steg), Hôpital Bichat, Paris, France.

Correspondence to: Jean-Pierre Laissy, MD, PhD, Department of Radiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France; e-mail: jean-pierre.laissy{at}bch.ap-hop-paris.fr

Study objectives: To explore the diagnostic performance of MRI for the diagnosis of acute myocarditis, using a comprehensive imaging approach.

Design and settings: Twenty patients with myocarditis and 7 age-matched and gender-matched control subjects underwent comprehensive MRI. Magnetic resonance (MR) examinations included axial T2-weighted sequences, precontrast and postcontrast ECG-gated T1-weighted sequences in axial and short heart axis, cine-MRI, and serial dynamic turbo fast low-angle shot (turboFLASH) acquisitions in the short axis following Gd injection for a period of 2 min. Precontrast and postcontrast images were postprocessed using subtraction. Two observers read all images qualitatively and quantitatively. Myocardial enhancement was compared between patients and control subjects.

Patients: Myocardial involvement was focal in 6 patients examined within 1 week from clinical onset, and diffuse in the remaining 14 patients examined later.

Results: Qualitatively, contrast-enhanced T1-weighted subtracted images had 100% sensitivity and specificity for myocardial involvement. Postcontrast T1-weighted images were able to discriminate the early phase (nodular enhancement) from the later phase of myocarditis (diffuse enhancement). Quantitatively, myocardial enhancement was 56% ± 3.2% in patients, vs 29% ± 3.1% in control subjects using T1-weighted MRI (p < 0.0001). Serial turboFLASH images displayed greater myocardial enhancement between 25 s and 120 s in patients than in control subjects (p < 0.0001); however, there was marked enhancement of skeletal muscles in both early and late stages of myocarditis compared to control subjects (p < 0.0001).

Conclusion: On the basis of subtracted cardiac-gated T1-weighted images and serial postinjection turboFLASH images, our study shows that myocarditis is largely, at least in the early stages, a focal process in the myocardium. It also provides evidence of transient skeletal muscle involvement, which may actually be useful for diagnosis.

Key Words: heart, diseases • heart, magnetic resonance • magnetic resonance, comparative studies • magnetic resonance, pulse sequences • magnetic resonance, rapid imaging • myocarditis

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