From Franz-Volhard-Klinik am Max Delbrück Centrum für
Molekulare Medizin, Virchow Klinikum, Humboldt Universität zu Berlin, and
the Institut für Diagnostische Radiologie, Städtisches Klinikum
Berlin-Buch (H.M.), Germany.
Correspondence to Matthias G. Friedrich, MD, Franz-Volhard-Klinik, Wiltbergstr 50, 13122 Berlin, Germany. E-mail friedrich{at}fvk-berlin.de
Background—The course of tissue
changes in acute myocarditis in humans is not well understood.
Diagnostic tools currently available are unsatisfactory. We
tested the hypothesis that inflammation is reflected by signal changes
in contrast-enhanced magnetic resonance imaging (MRI).
Methods and Results—We assessed 44 consecutive patients with
symptoms of acute myocarditis. Nineteen patients met the inclusion
criteria revealing ECG changes, reduced myocardial function, elevated
creatine kinase, positive troponin T, serological evidence for acute
viral infection, exclusion of coronary heart disease, and
positive antimyosin scintigraphy. We studied these patients
on days 2, 7, 14, 28, and 84 after the onset of symptoms. We obtained
ECG-triggered, T1-weighted images before and after application of
0.1 mmol/kg gadolinium. We measured the global relative signal
enhancement of the left ventricular myocardium
related to skeletal muscle and compared it with measurements in 18
volunteers. The global relative enhancement was higher in patients on
days 2 (4.8±0.3 [mean±SE] versus 2.5±0.2;
P<.0001); 7 (4.7±0.5, P<.0001); 14
(4.6±0.5, P<.0002); and 28 (3.9±0.4,
P=.009) but not on day 84 (3.1±0.3;
P=NS). On day 2, the enhancement was focal, whereas at
later time points, the enhancement was diffuse. In patients with
evidence of ongoing disease, the values remained elevated.
Conclusions—Acute myocarditis evolves from a focal to a
disseminated process during the first 2 weeks after onset of symptoms.
Contrast media–enhanced MRI visualizes the localization, activity, and
extent of inflammation and may serve as a powerful noninvasive
diagnostic tool in acute myocarditis.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis
Key Words: myocarditis • magnetic resonance imaging • contrast media
This article has been cited by other articles:
 |
|
 |
|
  H Abdel-Aty, N Siegle, A Natusch, E Gromnica-Ihle, R Wassmuth, R Dietz, and J Schulz-Menger Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach Lupus, June 1, 2008; 17(6): 561 - 567. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Germans and A. C van Rossum The use of cardiac magnetic resonance imaging to determine the aetiology of left ventricular disease and cardiomyopathy Heart, April 1, 2008; 94(4): 510 - 518. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gutberlet, B. Spors, T. Thoma, H. Bertram, T. Denecke, R. Felix, M. Noutsias, H.-P. Schultheiss, and U. Kuhl Suspected Chronic Myocarditis at Cardiac MR: Diagnostic Accuracy and Association with Immunohistologically Detected Inflammation and Viral Persistence Radiology, February 1, 2008; 246(2): 401 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U Sechtem, H Mahrholdt, and H Vogelsberg Cardiac magnetic resonance in myocardial disease Heart, December 1, 2007; 93(12): 1520 - 1527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Thanjan, P. Ramaswamy, W. W. Lai, and I. D. Lytrivi Acute Myopericarditis After Multiple Vaccinations in an Adolescent: Case Report and Review of the Literature Pediatrics, June 1, 2007; 119(6): e1400 - e1403. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Assomull, J. C. Lyne, N. Keenan, A. Gulati, N. H. Bunce, S. W. Davies, D. J. Pennell, and S. K. Prasad The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries Eur. Heart J., May 3, 2007; (2007) ehm113v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. D. Lewis, C. B. Holmes, G. Holmvang, and J. R. Butterton Case 8-2007 -- A 48-Year-Old Man with Chest Pain Followed by Cardiac Arrest N. Engl. J. Med., March 15, 2007; 356(11): 1153 - 1162. [Full Text] [PDF]
|
|
|
|
 |
|
 H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper Noninvasive Imaging in Myocarditis J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2085 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. E. Lundberg The heart in dermatomyositis and polymyositis Rheumatology, October 1, 2006; 45(suppl_4): iv18 - iv21. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Vogel-Claussen, C. E. Rochitte, K. C. Wu, I. R. Kamel, T. K. Foo, J. A. C. Lima, and D. A. Bluemke Delayed enhancement MR imaging: utility in myocardial assessment. RadioGraphics, May 1, 2006; 26(3): 795 - 810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Schulz-Menger, R Wassmuth, H Abdel-Aty, I Siegel, A Franke, R Dietz, and M G Friedrich Patterns of myocardial inflammation and scarring in sarcoidosis as assessed by cardiovascular magnetic resonance. Heart, March 1, 2006; 92(3): 399 - 400. [Full Text] [PDF]
|
|
|
|
|
|
E Perugini, C Rapezzi, T Piva, O Leone, L Bacchi-Reggiani, L Riva, F Salvi, L Lovato, A Branzi, and R Fattori Non-invasive evaluation of the myocardial substrate of cardiac amyloidosis by gadolinium cardiac magnetic resonance Heart, March 1, 2006; 92(3): 343 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Messroghli, S. Plein, D. M. Higgins, K. Walters, T. R. Jones, J. P. Ridgway, and M. U. Sivananthan Human Myocardium: Single-Breath-hold MR T1 Mapping with High Spatial Resolution--Reproducibility Study Radiology, March 1, 2006; 238(3): 1004 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Magnani and G. W. Dec Myocarditis: Current Trends in Diagnosis and Treatment Circulation, February 14, 2006; 113(6): 876 - 890. [Full Text] [PDF]
|
|
|
|
 |
|
 Y Allanore, O Vignaux, L Arnaud, X Puechal, S Pavy, D Duboc, P Legmann, and A Kahan Effects of corticosteroids and immunosuppressors on idiopathic inflammatory myopathy related myocarditis evaluated by magnetic resonance imaging Ann Rheum Dis, February 1, 2006; 65(2): 249 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Laissy, F. Hyafil, L. J. Feldman, J.-M. Juliard, E. Schouman-Claeys, P. G. Steg, and M. Faraggi Differentiating Acute Myocardial Infarction from Myocarditis: Diagnostic Value of Early- and Delayed-Perfusion Cardiac MR Imaging Radiology, October 1, 2005; 237(1): 75 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I E Lundberg Cardiac involvement in autoimmune myositis and mixed connective tissue disease Lupus, September 1, 2005; 14(9): 708 - 712. [Abstract] [PDF]
|
|
|
|
|
|
H. Mahrholdt, A. Wagner, R. M. Judd, U. Sechtem, and R. J. Kim Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies Eur. Heart J., August 1, 2005; 26(15): 1461 - 1474. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Abdel-Aty, P. Boye, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M. G. Friedrich, and J. Schulz-Menger Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1815 - 1822. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P. Liu and A. T. Yan Cardiovascular Magnetic Resonance for the Diagnosis of Acute Myocarditis: Prospects for Detecting Myocardial Inflammation J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1823 - 1825. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Knaapen, W. G. van Dockum, O. Bondarenko, W. E.M. Kok, M. J.W. Gotte, R. Boellaard, A. M. Beek, C. A. Visser, A. C. van Rossum, A. A. Lammertsma, et al. Delayed Contrast Enhancement and Perfusable Tissue Index in Hypertrophic Cardiomyopathy: Comparison Between Cardiac MRI and PET J. Nucl. Med., June 1, 2005; 46(6): 923 - 929. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Hunold, T. Schlosser, F. M. Vogt, H. Eggebrecht, A. Schmermund, O. Bruder, W. O. Schuler, and J. Barkhausen Myocardial Late Enhancement in Contrast-Enhanced Cardiac MRI: Distinction Between Infarction Scar and Non-Infarction-Related Disease Am. J. Roentgenol., May 1, 2005; 184(5): 1420 - 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J A Singh, P K Woodard, V G Davila-Roman, A D Waggoner, F R Gutierrez, J Zheng, and S A Eisen Cardiac magnetic resonance imaging abnormalities in systemic lupus erythematosus: a preliminary report Lupus, February 1, 2005; 14(2): 137 - 144. [Abstract] [PDF]
|
|
|
|
|
|
D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Cassimatis, J. E. Atwood, R. M. Engler, P. E. Linz, J. D. Grabenstein, and M. N. Vernalis Smallpox vaccination and myopericarditis: a clinical review J. Am. Coll. Cardiol., May 5, 2004; 43(9): 1503 - 1510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Mahrholdt, C. Goedecke, A. Wagner, G. Meinhardt, A. Athanasiadis, H. Vogelsberg, P. Fritz, K. Klingel, R. Kandolf, and U. Sechtem Cardiovascular Magnetic Resonance Assessment of Human Myocarditis: A Comparison to Histology and Molecular Pathology Circulation, March 16, 2004; 109(10): 1250 - 1258. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. O. Cheng Prevalence of Viral Myocarditis Arch Intern Med, July 28, 2003; 163(14): 1742 - 1742. [Full Text] [PDF]
|
|
|
|
 |
|
 J.-P. Laissy, B. Messin, O. Varenne, B. Iung, D. Karila-Cohen, E. Schouman-Claeys, and P. G. Steg MRI of Acute Myocarditis: A Comprehensive Approach Based on Various Imaging Sequences Chest, November 1, 2002; 122(5): 1638 - 1648. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Lauerma, P. Niemi, H. Hänninen, T. Janatuinen, L.-M. Voipio-Pulkki, J. Knuuti, L. Toivonen, T. Mäkelä, M. A. Mäkijärvi, and H. J. Aronen Multimodality MR Imaging Assessment of Myocardial Viability: Combination of First-Pass and Late Contrast Enhancement to Wall Motion Dynamics and Comparison with FDG PET-Initial Experience Radiology, December 1, 2000; 217(3): 729 - 736. [Abstract] [Full Text]
|
|
|
|
|
|
A. M. Feldman and D. McNamara Myocarditis N. Engl. J. Med., November 9, 2000; 343(19): 1388 - 1398. [Full Text] [PDF]
|
|
|
|
|
|
A Angelini, V Calzolari, F Calabrese, G M Boffa, F Maddalena, R Chioin, and G Thiene Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis Heart, September 1, 2000; 84(3): 245 - 250. [Abstract] [Full Text] [PDF]
|
|