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Contrast-enhanced cine MR sequences in the assessment of myocardial hyperemia in acute myocarditis: can they help? A feasibility study

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Abstract

The study was designed to assess the accuracy of contrast-enhanced balanced steady-state free precession (cine-SSFP) CMR imaging sequences to exhibit myocardial hyperemia in acute myocarditis, which has for a long time been investigated in some centers using early gadolinium enhancement (EGE) sequence. Contrast-enhanced cine-SSFP (CESSFP) sequences were compared to precontrast cine-SSFP sequences to calculate the early cine-contrast enhancement in 36 consecutive patients with acute myocarditis and 36 controls matched for age and gender. Four-chamber views images were obtained in each subject before and after gadolinium injection. Absolute and relative left ventricular myocardial enhancement of the overall myocardium, then separately of the lateral wall and interventricular septum was analyzed in telediastole. Myocarditis patients displayed higher cine-SSFP absolute enhancement than controls (overall left ventricular myocardium 2.38 ± 0.33 vs 1.84 ± 0.31; lateral wall 2.45 ± 0.35 vs 1.83 ± 0.32; and septum 2.26 ± 0.29 vs 1.82 ± 0.29, p < 0.0001 for all). Less significant differences were observed for the relative enhancement (p < 0.05 for all). Using ROC curves, the optimal threshold value of absolute enhancement to diagnose acute myocarditis was 2.05 (sensitivity: 86%; specificity: 81%). Given the simplicity of use, contrast-enhanced cine-SSFP sequences should be used as an additional diagnostic tool to detect hyperemia in acute myocarditis patients.

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Abbreviations

CE:

Contrast-enhanced

CMR:

Cardiac magnetic resonance

LV:

Left ventricular

SSFP:

Steady-state free precession

2D:

Two-dimensional

3D:

Three-dimensional

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Authors and Affiliations

  1. Departments of Radiology, Hôpital Bichat AP-HP, 46 Rue Henri Huchard, 75877, Paris Cedex 18, France

    Jean-Pierre Laissy & Ahmed Bendriss

  2. Departments of Radiology, Hôpital Lariboisière APHP, 2 Rue Ambroise Paré, 75010, Paris, France

    Jean-Pierre Laissy, Théo Pezel, Christine Herbin & Clémentine Corino

  3. Departments of Cardiology, Hôpital Lariboisière APHP, University de Paris, Paris, France

    Théo Pezel

  4. INSERM U1148, University de Paris, Paris, France

    Jean-Pierre Laissy & Ahmed Bendriss

  5. DHU FIRE, University de Paris, Paris, France

    Jean-Pierre Laissy & Ahmed Bendriss

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  1. Jean-Pierre Laissy
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Correspondence to Jean-Pierre Laissy.

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Laissy, JP., Pezel, T., Herbin, C. et al. Contrast-enhanced cine MR sequences in the assessment of myocardial hyperemia in acute myocarditis: can they help? A feasibility study. Heart Vessels 38, 662–670 (2023). https://doi.org/10.1007/s00380-022-02207-8

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