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Suspected Chronic Myocarditis at Cardiac MR: Diagnostic Accuracy and Association with Immunohistologically Detected Inflammation and Viral Persistence¹

¹ From the Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité, Campus Virchow Klinikum (M.G., B.S., T.T., H.B., T.D., R.F.); and Department of Cardiology, Charité, Campus Benjamin Franklin (M.N., H.P.S., U.K.), Universitätsmedizin Berlin, Berlin, Germany. From the 2006 RSNA Annual Meeting. Received December 23, 2006; revision requested February 13, 2007; revision received March 7; accepted April 13; final version accepted June 1. U.K. and H.P.S. supported in part by a grant from the Deutsche Forschungsgemeinschaft through Sonderforschungsbereich/Transregio 19 TPZ1. Address correspondence to M.G., Department of Diagnostic and Interventional Radiology, University Leipzig/Herzzentrum (Heart Institute) Leipzig, Strümpelstrasse 39, 04289 Leipzig, Germany (e-mail: matthias.gutberlet{at}herzzentrum-leipzig.de).

Purpose: To retrospectively compare the diagnostic accuracy of three cardiac magnetic resonance (MR) imaging approaches for the detection of histologic and immunohistologic criteria (reference standard) proved myocardial inflammation in patients clinically suspected of having chronic myocarditis (CMC).

Materials and Methods: Cardiac MR imaging was performed in 83 consecutive patients (55 male, 28 female; mean age, 44.8 years ± 17.7 [standard deviation]) clinically suspected of having CMC, after written informed consent was obtained according to guidelines of the local ethics committee, which approved the study. T2-weighted triple-inversion-recovery imaging to calculate the edema ratio (ER), T1-weighted imaging before and after contrast agent administration to calculate the myocardial global relative enhancement (gRE), and inversion-recovery gradient-echo imaging to evaluate areas of late gadolinium enhancement (LE) were performed. The MR results were correlated with the endomyocardial biopsy (EMB) findings to detect intramyocardial inflammation and cardiotropic viral genomes analyzed at polymerase chain reaction assay. For statistical analyses, receiver operating characteristic analysis and the Wilcoxon test for unpaired data were used because the Kolomogorov-Smirnov test revealed a distribution of data that was different from normality.

Results: Intramyocardial inflammation and cardiotropic viral persistence were confirmed at immunohistologic analysis in 48 and 49 of the 83 patients, respectively. The sensitivity, specificity, and diagnostic accuracy of the MR parameters, as compared with the immunohistologic detection of inflammation, were, respectively, 62%, 86%, and 72% for gRE; 67%, 69%, and 68% for ER; and 27%, 80%, and 49% for LE. Cardiac MR–derived gRE, ER, and LE were not associated with polymerase chain reaction proof of viral genomes.

Conclusion: In patients clinically suspected of having CMC, increased gRE and ER indicating inflammation were common findings that could be confirmed at immunohistologic analysis, whereas LE had low sensitivity and accuracy. Cardiac MR imaging may be helpful in detecting intramyocardial inflammation noninvasively, but it fails to depict viral persistence.

Supplemental material: http://radiology.rsnajnls.org/cgi/content/full/2461062179/DC1

© RSNA, 2008

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