Quantitative Assessment of Late Gadolinium Enhancement and Edema at Cardiac Magnetic Resonance in Low-Risk Myocarditis Patients

Monti CB, Secchi F, Alì M, Carbone FS, Bonomo L, Capra D, Mobini N, Di Leo G, Sardanelli F. Quantitative Assessment of Late Gadolinium Enhancement and Edema at Cardiac Magnetic Resonance in Low-Risk Myocarditis Patients. Tomography. 2022 Apr 1;8(2):974-984. doi: 10.3390/tomography8020078. PMID: 35448712; PMCID: PMC9028348.

Abstract

In this study, we aimed to quantify LGE and edema at short-tau inversion recovery sequences on cardiac magnetic resonance (CMR) in patients with myocarditis. We retrospectively evaluated CMR examinations performed during the acute phase and at follow-up. Forty-seven patients were eligible for retrospective LGE assessment, and, among them, twenty-five patients were eligible for edema evaluation. Both groups were paired with age- and sex-matched controls. The median left ventricle LGE was 6.4% (interquartile range 5.0-9.2%) at the acute phase, 4.4% (3.3-7.2%) at follow-up, and 4.3% (3.0-5.3%) in controls, the acute phase being higher than both follow-up and controls (p < 0.001 for both), while follow-up and controls did not differ (p = 0.139). An optimal threshold of 5.0% was obtained for LGE with 87% sensitivity and 48% specificity; the positive likelihood ratio (LR) was 1.67, and the negative LR was 0.27. Edema was 12.8% (9.4-18.1%) at the acute phase, 7.3% (5.5-8.8%) at follow-up, and 6.7% (5.6-8.6%) in controls, the acute phase being higher than both follow-up and controls (both p < 0.001), while follow-up and controls did not differ (p = 0.900). An optimal threshold of 9.5% was obtained for edema with a sensitivity of 76% and a specificity of 88%; the positive LR was 6.33, and the negative LR was 0.27. LGE and edema thresholds are useful in cases of suspected mild myocarditis.