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Detection of myocarditis using T 1 and ECV mapping is not improved by early compared to late post‐contrast imaging
Author(s) -
Lundin Magnus,
Sörensson Peder,
Vishnevskaya Liya,
Maret Eva,
Kellman Peter,
Sigfridsson Andreas,
Ugander Martin
Publication year - 2019
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12588
Subject(s) - medicine , myocarditis , magnetic resonance imaging , cardiology , acute myocarditis , contrast (vision) , contrast enhancement , nuclear medicine , radiology , artificial intelligence , computer science
Summary Background Cardiovascular magnetic resonance (CMR) of myocarditis may include early gadolinium enhancement (EGE) and global relative enhancement (GRE) by T 1 ‐weighted images acquired before and early after contrast administration. However, the importance of timing for post‐contrast imaging has not been evaluated using T 1 mapping. We aimed to improve the understanding of the contrast mechanisms by evaluating whether early or late post‐contrast T 1 mapping was better at detecting myocarditis. Methods Controls and patients referred to evaluate myocarditis underwent 1·5T CMR. T 1 mapping was performed before, and 3 min (early) and 21 min (late) after intravenous contrast (0·2 mmol kg −1 ). Extracellular volume fraction (ECV) and the GRE and EGE equivalents by T 1 mapping were calculated. Focally affected myocardium in myocarditis was defined as increased native T 1 compared to remote myocardium. Results The GRE equivalent by T 1 mapping was higher in myocarditis ( n = 19) compared to controls ( n = 19) both early ( P <0·001) and late ( P <0·001). While remote myocardium in myocarditis had higher enhancement relative to skeletal muscle compared to controls early ( P = 0·002) and late ( P <0·001), ECV of skeletal muscle was lower compared to controls both early ( P = 0·03) and late ( P = 0·004), and remote myocardial ECV did not differ from controls early ( P = 0·37) or late ( P = 0·52). The difference in ECV between affected and remote myocardium was higher late compared to early by 5·3 ± 0·7 versus 4·0 ± 0·6%‐points ( P = 0·002). Conclusion Quantitative evaluation by T 1 mapping shows that early post‐contrast imaging does not improve the detection of myocarditis compared to late post‐contrast imaging. Focal myocardial abnormalities were more conspicuous late post‐contrast.