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European Radiology

Open Access 04-05-2024 | Myocarditis | Cardiac

Comparative analysis of late gadolinium enhancement assessment techniques for monitoring fibrotic changes in myocarditis follow-up

Authors: Mihály Károlyi, Malgorzata Polacin, Márton Kolossváry, Justyna M. Sokolska, Ioannis Matziris, Lucas Weber, Hatem Alkadhi, Robert Manka

Published in: European Radiology

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Abstract

Objectives

To compare the repeatability and interrelation of various late gadolinium enhancement (LGE) assessment techniques for monitoring fibrotic changes in myocarditis follow-up.

Materials and methods

LGE extent change between baseline and 3-month cardiovascular magnetic resonance (CMR) was compared in patients with acute myocarditis using the full width at half maximum (FWHM), gray-scale thresholds at 5 and 6 standard deviations (SD5 and SD6), visual assessment with threshold (VAT) and full manual (FM) techniques. In addition, visual presence score (VPS), visual transmurality score (VTS), and a simplified visual change score (VCS) were assessed. Intraclass-correlation (ICC) was used to evaluate repeatability, and methods were compared using Spearman’s correlation.

Results

Forty-seven patients (38 male, median age: 27 [IQR: 21; 38] years) were included. LGE extent change differed among quantitative techniques (p < 0.01), with variability in the proportion of patients showing LGE change during follow-up (FWHM: 62%, SD5: 74%, SD6: 66%, VAT: 43%, FM: 60%, VPS: 53%, VTS: 77%, VCS: 89%). Repeatability was highest with FWHM (ICC: 0.97) and lowest with SD5 (ICC: 0.89). Semiquantitative scoring had slightly lower values (VPS ICC: 0.81; VTS ICC: 0.71). VCS repeatability was excellent (ICC: 0.93). VPS and VTS correlated with quantitative techniques, while VCS was positively associated with VPS, VTS, VAT, and FM, but not with FWHM, SD5, and SD6.

Conclusion

FWHM offers the least observer-dependent LGE follow-up after myocarditis. VPS, VTS, and VCS are practical alternatives, showing reliable correlations with quantitative methods. Classification of patients exhibiting either stable or changing LGE relies on the assessment technique.

Clinical relevance statement

This study shows that LGE monitoring in myocarditis is technique-dependent; the FWHM method yields the most consistent fibrotic tracking results, with scoring-based techniques as reliable alternatives.

Key Points

  • Recognition of fibrotic changes during myocarditis follow-up is significantly influenced by the choice of the quantification technique employed.
  • The FWHM technique ensures highly repeatable tracking of myocarditis-related LGE changes.
  • Segment-based visual scoring and the simplified visual change score offer practical, reproducible alternatives in resource-limited settings.
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Metadata
Title
Comparative analysis of late gadolinium enhancement assessment techniques for monitoring fibrotic changes in myocarditis follow-up
Authors
Mihály Károlyi
Malgorzata Polacin
Márton Kolossváry
Justyna M. Sokolska
Ioannis Matziris
Lucas Weber
Hatem Alkadhi
Robert Manka
Publication date
04-05-2024
Publisher
Springer Berlin Heidelberg
Keyword
Myocarditis
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10756-x