scholarly journals Multiparametric cardiac magnetic resonance imaging in pediatric and adolescent patients with acute myocarditis

2021 ◽  
Author(s):  
Alexander Isaak ◽  
Leon M. Bischoff ◽  
Anton Faron ◽  
Christoph Endler ◽  
Narine Mesropyan ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Diagnostic Performance ◽  
Operating Characteristic ◽  
Acute Myocarditis ◽  
Relaxation Times ◽  
Diagnostic Value ◽  
T2 Relaxation ◽  
Mapping Parameters ◽  
Adolescent Patients

Abstract Background The diagnostic value of cardiac magnetic resonance imaging (MRI) employing the 2018 Lake Louise criteria in pediatric and adolescent patients with acute myocarditis is undefined. Objective To evaluate the diagnostic value of the Lake Louise criteria in pediatric and adolescent patients with suspected acute myocarditis and to show the utility of cardiac MRI for follow-up in this patient cohort. Materials and methods Forty-three patients (age range: 8–21 years) with suspected acute myocarditis and 13 control patients who underwent cardiac MRI were retrospectively analyzed. T2-weighted and late gadolinium enhancement imaging were performed in all patients. T1 and T2 mapping were available in 26/43 patients (60%). The Lake Louise criteria were assessed. In 27/43 patients (63%), cardiac MRI follow-up was available. Receiver operating characteristic analysis, Pearson’s correlation coefficient and paired Student’s t-test were used for statistical analysis. Results In the total cohort, the Lake Louise criteria achieved a sensitivity of 86% (95% confidence interval [CI]: 72–95%) and a specificity of 100% (95% CI: 79–100%) for the diagnosis of acute myocarditis. In the subgroup of patients with available mapping parameters, the diagnostic performance of the Lake Louise criteria was higher when mapping parameters were implemented into the score (area under the receiver operating characteristic curve: 0.944 vs. 0.870; P=0.033). T2 relaxation times were higher in patients with admission to the intermediate care unit and were associated with the length of intermediate care unit stay (r=0.879, P=0.049). Cardiac MRI markers of active inflammation decreased on follow-up examinations (e.g., T1 relaxation times: 1,032±39 ms vs. 975±33 ms, P<0.001; T2 relaxation times: 58±5 ms vs. 54±5 ms, P=0.003). Conclusion The Lake Louise criteria have a high diagnostic performance for the diagnosis of acute myocarditis and are a valuable tool for follow-up in pediatric and adolescent patients. The mapping techniques enhance the diagnostic performance of the 2018 Lake Louise criteria.

Cardiac Magnetic Resonance Quantitative Tissue Markers in the Clinical Application Value for the Diagnosis of Acute Myocarditis

2018 ◽  
Vol 8 (9) ◽  
pp. 1751-1756 ◽  
Author(s):  
Liu Gang ◽  
Zeng Mu ◽  
Ma Zenglin ◽  
Liu Jiayi ◽  
Fan Zhanming ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Diagnostic Performance ◽  
Acute Myocarditis ◽  
Relaxation Times ◽  
Mapping Technique ◽  
Operating Characteristics ◽  
T2 Relaxation ◽  
Gadolinium Enhancement

Objectives: To determine the value of cardiac magnetic resonance (CMR) quantitative tissue markers in the diagnosis of acute myocarditis, compared with the traditional Lake-Louise criteria (LLC). Methods: Totally 35 cases of patients diagnosed as acute myocarditis in Beijing Anzhen Hospital and 35 healthy volunteers were enrolled in our study, from May 2014 to August 2016. CMR protocol included quantitative assessment of T1 relaxation times using modified Look-Locker inversion recovery (MOLLI), extracellular volume fraction (ECV), T2 relaxation times. Established Lake-Louise criteria (LLC) consisting of T2-weighted signal intensity ratio (T2-ratio), early gadolinium enhancement ratio (EGEr), and late gadolinium enhancement (LGE) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic performance. Results: T2-ratio (1.85±0.21 vs. 1.58±0.15; P = 0.002) and EGEr (3.87±1.62 vs. 2.15±1.36; P =0.024) were significantly higher in myocarditis subjects than in control subjects. Non-ischemic LGE was found in 27/35 (77.1%) of all myocarditis patients. Regional myocardial edema was found in 23/35 (65.7%) of all myocarditis patients. Myocardial T1 and T2 relaxation times and ECV were significantly prolonged in the myocarditis group compared with the control group (T1 native relaxation time: 1310±62 vs. 1247±27 ms, T2 native relaxation time: 65.46±8.49 vs. 55.17±3.59 ms; ECV: 34.47±8.52 vs. 27.68±5.82, P < 0.001, respectively). Areas under the curve of native T1 (0.94) and T2 relaxation times (0.91) were higher compared with those of the other CMR parameters (T2-ratio: 0.73, EGEr: 0.72, LGE: 0.88, LLC: 0.90, ECV: 0.79). Combined with LGE, each native mapping technique outperformed the diagnostic performance of LLC (P < 0.01, respectively). A combination of native parameters (T1, T2 relaxation times) significantly increased the diagnostic performance of CMR compared with LLC without need of contrast media application (0.99 vs. 0.90; P < 0.05). Conclusion: CMR quantitative tissue markers has good diagnostic efficiency for acute myocarditis, it may be potential to replace the Lake-Louise criteria in the future in patients with contraindications for the use of gadolinium-based contrast agents.

scholarly journals Multiparametric Cardiovascular Magnetic Resonance in Acute Myocarditis: Comparison of 2009 and 2018 Lake Louise Criteria With Endomyocardial Biopsy Confirmation

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuang Li ◽  
Xuejing Duan ◽  
Guangxun Feng ◽  
Arlene Sirajuddin ◽  
Gang Yin ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Endomyocardial Biopsy ◽  
Diagnostic Performance ◽  
T1 Mapping ◽  
Acute Myocarditis ◽  
T2 Mapping ◽  
Relaxation Times ◽  
T2 Relaxation ◽  
3.0 T ◽  
Combined Parameters

Background: Cardiac magnetic resonance (CMR) has been shown to improve the diagnosis of myocarditis, but no systematic comparison of this technique is currently available. The purpose of this study was to compare the 2009 and 2018 Lake Louise Criteria (LLC) for the diagnosis of acute myocarditis using 3.0 T MRI with endomyocardial biopsy (EMB) as a reference and to provide the cutoff values for multiparametric CMR techniques.Methods: A total of 73 patients (32 ± 14 years, 71.2% men) with clinically suspected myocarditis undergoing EMB and CMR with 3.0 T were enrolled in the study. Patients were divided into two groups according to EMB results (EMB-positive and -negative groups). The CMR protocol consisted of cine-SSFP, T2 STIR, T2 mapping, early and late gadolinium enhancement (EGE, LGE), and pre- and post-contrast T1 mapping. Their potential diagnostic ability was assessed with receiver operating characteristic curves.Results: The myocardial T1 and T2 relaxation times were significantly higher in the EMB-positive group than in the EMB-negative group. Optimal cutoff values were 1,228 ms for T1 relaxation times and 58.5 ms for T2 relaxation times with sensitivities of 86.0 and 83.7% and specificities of 93.3 and 93.3%, respectively. The 2018 LLC had a better diagnostic performance than the 2009 LLC in terms of sensitivity, specificity, positive predictive value, and negative predictive value. T1 mapping + T2 mapping had the largest area under the curve (0.95) compared to other single or combined parameters (2018 LLC: 0.91; 2009 LLC: 0.76; T2 ratio: 0.71; EGEr: 0.67; LGE: 0.73; ). The diagnostic accuracy for the 2018 LLC was the highest (91.8%), followed by T1 mapping (89.0%) and T2 mapping (87.7%).Conclusion: Emerging technologies such as T1/ T2 mapping have significantly improved the diagnostic performance of CMR for the diagnosis of acute myocarditis. The 2018 LLC provided the overall best diagnostic performance in acute myocarditis compared to other single standard CMR parameters or combined parameters. There was no significant gain when 2018LLC is combined with the EGE sequence.

Diagnostic value of ECG-gated multidetector computed tomography in the early phase of suspected acute myocarditis. A preliminary comparative study with cardiac MRI

2006 ◽  
Vol 17 (2) ◽  
pp. 331-338 ◽  
Author(s):  
Grégoire Dambrin ◽  
Jean Pierre Laissy ◽  
Jean Michel Serfaty ◽  
Christophe Caussin ◽  
Bernard Lancelin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Multidetector Computed Tomography ◽  
Cardiac Mri ◽  
Early Phase ◽  
Acute Myocarditis ◽  
Diagnostic Value

scholarly journals Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction

2020 ◽  
Author(s):  
Narine Mesropyan ◽  
Patrick Kupczyk ◽  
Leona Dold ◽  
Tobias J. Weismüller ◽  
Alois M. Sprinkart ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Liver Stiffness ◽  
Extracellular Volume Fraction ◽  
Diagnostic Value ◽  
Parametric Mapping ◽  
Significant Fibrosis ◽  
Non Invasive ◽  
Mapping Parameters

Abstract Purpose Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that leads to severe fibrosis and cirrhosis. The aim of this study was to determine the diagnostic value of T1 and T2 mapping as well as extracellular volume fraction (ECV) for non-invasive assessment of liver fibrosis in AIH patients. Methods In this prospective study, 27 patients (age range: 19–77 years) with AIH underwent liver MRI. T1 and T2 relaxation times as well as ECV were quantified by mapping techniques. The presence of significant fibrosis (≥ F2) was defined as magnetic resonance elastography (MRE)-based liver stiffness ≥ 3.66 kPa. MRE was used as reference standard, against which the diagnostic performance of MRI-derived mapping parameters was tested. Diagnostic performance was compared by utilizing receiver-operating characteristic (ROC) analysis. Results MRE-based liver stiffness correlated with both, hepatic native T1 (r = 0.69; P < 0.001) as well as ECV (r = 0.80; P < 0.001). For the assessment of significant fibrosis, ECV yielded a sensitivity of 85.7% (95% confidence interval (CI): 60.1–96.0%) and a specificity of 84.6% (CI 60.1–96.0%); hepatic native T1 yielded a sensitivity of 85.7% (CI 60.1–96.0%); and a specificity of 76.9% (CI 49.7–91.8%). Diagnostic performance of hepatic ECV (area under the curve (AUC): 0.885), native hepatic T1 (AUC: 0.846) for assessment of significant fibrosis was similar compared to clinical fibrosis scores (APRI (AUC: 0.852), FIB-4 (AUC: 0.758), and AAR (0.654) (P > 0.05 for each comparison)). Conclusion Quantitative mapping parameters such as T1 and ECV can identify significant fibrosis in AIH patients. Future studies are needed to explore the value of parametric mapping for the evaluation of different disease stages.

scholarly journals 104 Contribution of cardiac MRI to early evaluation and impact on the long term follow-up in acute myocarditis. A 31-cases prospective study

2011 ◽  
Vol 3 (1) ◽  
pp. 33
Author(s):  
Philippe Paule ◽  
Yves Chabrillat ◽  
Nicolas Charles Roche ◽  
Jacques Quilici ◽  
Christophe Jego ◽  
...  
Keyword(s):  
Prospective Study ◽  
Cardiac Mri ◽  
Acute Myocarditis ◽  
Early Evaluation ◽  
Long Term Follow Up

scholarly journals CMR Tissue Characterization in Patients with HFmrEF

2019 ◽  
Vol 8 (11) ◽  
pp. 1877 ◽  
Author(s):  
Patrick Doeblin ◽  
Djawid Hashemi ◽  
Radu Tanacli ◽  
Tomas Lapinskas ◽  
Rolf Gebker ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Tissue Characterization ◽  
Statistical Significance ◽  
Systolic Dysfunction ◽  
Extracellular Volume ◽  
Relaxation Times ◽  
Healthy Controls ◽  
T2 Relaxation ◽  
Reduced Ejection Fraction ◽  
T1 Relaxation

The characteristics and optimal management of heart failure with a moderately reduced ejection fraction (HFmrEF, LV-EF 40–50%) are still unclear. Advanced cardiac MRI offers information about function, fibrosis and inflammation of the myocardium, and might help to characterize HFmrEF in terms of adverse cardiac remodeling. We, therefore, examined 17 patients with HFpEF, 18 with HFmrEF, 17 with HFrEF and 17 healthy, age-matched controls with cardiac MRI (Phillips 1.5 T). T1 and T2 relaxation time mapping was performed and the extracellular volume (ECV) was calculated. Global circumferential (GCS) and longitudinal strain (GLS) were derived from cine images. GLS (−15.7 ± 2.1) and GCS (−19.9 ± 4.1) were moderately reduced in HFmrEF, resembling systolic dysfunction. Native T1 relaxation times were elevated in HFmrEF (1027 ± 40 ms) and HFrEF (1033 ± 54 ms) compared to healthy controls (972 ± 31 ms) and HFpEF (985 ± 32 ms). T2 relaxation times were elevated in HFmrEF (55.4 ± 3.4 ms) and HFrEF (56.0 ± 6.0 ms) compared to healthy controls (50.6 ± 2.1 ms). Differences in ECV did not reach statistical significance. HFmrEF differs from healthy controls and shares similarities with HFrEF in cardiac MRI parameters of fibrosis and inflammation.

Microneurosurgical Treatment of Intracranial Dermoid and Epidermoid Tumors

Neurosurgery ◽  
1989 ◽  
Vol 24 (4) ◽  
pp. 561-567 ◽  
Author(s):  
M. Gazi Yaşargil ◽  
Chad D. Abernathey ◽  
Ali ç. Sarioglu
Keyword(s):  
Cranial Nerve ◽  
Relaxation Times ◽  
T2 Relaxation ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Cranial Nerve Palsies ◽  
Dermoid Tumor ◽  
Similar Appearance ◽  
Male To Female

ABSTRACT Forty-three patients with intracranial, intradural dermoid (8) and epidermoid (35) tumors underwent radical surgical resection utilizing strict microneurosurgical technique. The average age was 37.3 years for the patients with epidermoid tumors and 36.2 years for the patients with dermoid tumors. The male to female ratio was 3:2 for the epidermoid group and 3:1 for the dermoid group. Common clinical presentations included cerebellar dysfunction, cranial nerve impairment, and seizures. Typically, computed tomography scans revealed the epidermoid tumors (30 cases studied) as nonhomogeneous hypodense lesions with irregular borders and without contrast enhancement. The dermoid tumors (7 cases studied) had a similar appearance, but with a wider range of attenuation values. Magnetic resonance imaging findings for the epidermoid tumors (6 cases studied) consisted of increased T1 and increased T2 relaxation times. Supratentorial tumors were excised by the pterional (frontosphenotemporal) approach, mesencephalic tumors by either a supratentorial posterior interhemispheric transtentorial approach or an infratentorial/supracerebellar method, and posterior fossa tumors by either a medially or laterally positioned suboccipital osteoplastic craniotomy. One epidermoid tumor and one dermoid tumor were considered to be subtotally resected because of dense adherences left attached to vital structures; the remaining 41 tumors were completely excised. The most frequent complications were aseptic/chemical meningitis and transient cranial nerve palsies. There were no perioperative deaths. Mean follow-up was 5.2 years. Eighty-six percent of patients reported good to excellent results. No patient had experienced symptomatic or radiographic evidence of recurrence. These results suggest that although dermoid and epidermoid tumors tend to cross anatomical boundaries via the subarachnoid system, in the majority of patients tumors can be resected in their entirety with relatively low morbidity by utilizing microneurosurgical techniques.

scholarly journals Meniscal and Cartilage Changes on Serial MRI After Medial Opening-Wedge High Tibial Osteotomy

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110479
Author(s):  
Han Gyeol Choi ◽  
Yu Suhn Kang ◽  
Joo Sung Kim ◽  
Han Sang Lee ◽  
Yong Seuk Lee
Keyword(s):  
Tibial Plateau ◽  
Femoral Condyle ◽  
Relaxation Times ◽  
Lateral Compartment ◽  
Tibial Osteotomy ◽  
T2 Relaxation ◽  
Opening Wedge ◽  
Wedge High Tibial Osteotomy ◽  
Serial Mri

Background: Assessments of the effects of realignment using opening-wedge high tibial osteotomy (OWHTO) on the medial, lateral, and patellofemoral compartments have been limited to cartilage evaluations. Purpose/Hypothesis: The purpose was to evaluate the effects of OWHTO on the meniscus and cartilage of each compartment as a cooperative unit (meniscochondral unit) using serial magnetic resonance imaging (MRI). It was hypothesized that (1) favorable changes in the meniscochondral unit would occur in the medial compartment and (2) that changes in the patellofemoral and lateral compartments would be negligible. Study Design: Case series; Level of evidence, 4. Methods: Included were 36 knees that underwent OWHTO from March 2014 to February 2016 and had postoperative serial MRI. The MRI was performed at 19.9 ± 7.4 and 52.3 ± 8.3 months postoperatively, and the cartilage and meniscal changes were evaluated by highlighting the regions of interest. We evaluated the T2 relaxation times of each cartilage and meniscal area, the cross-sectional area of the menisci, and the extrusion of the medial meniscus (MM). The meniscochondral unit was assessed using subgroup analyses according to the status of the MM. Results: Significant decreases were seen in T2 relaxation times in the medial femoral condyle (MFC) ( P < .001) and medial tibial plateau (MTP) ( P = .050), and significant increases were seen in the lateral femoral condyle (LFC) ( P = .036). The change was more prominent in the MFC compared with the MTP and LFC ( P = .003). No significant changes were observed in the lateral tibial plateau, patella, or trochlear groove. The area of the lateral meniscus (body and posterior horn) was decreased compared with preoperative MRI ( P < .001 for both). The extent of MM extrusion decreased between the preoperative, first follow-up, and second follow-up MRIs ( P < .001). Conclusion: OWHTO affected the medial compartment positively, the lateral compartment negatively, and the patellofemoral compartment negligibly. The effects were more prominent and consistent in the medial than in the lateral compartment.

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