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Insights into Imaging
Published in: Insights into Imaging 1/2016

Open Access 01-02-2016 | Opinion

Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis

Authors: Antonio Esposito, Marco Francone, Riccardo Faletti, Maurizio Centonze, Filippo Cademartiri, Iacopo Carbone, Roberto De Rosa, Ernesto Di Cesare, Ludovico La Grutta, Guido Ligabue, Luigi Lovato, Erica Maffei, Riccardo Marano, Massimo Midiri, Gianluca Pontone, Luigi Natale, Francesco De Cobelli, From the Working Group of the Italian College of Cardiac Radiology by SIRM

Published in: Insights into Imaging | Issue 1/2016

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Abstract

Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease.

Main messages

• CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc.
• Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms.
• T1 mapping allows objective quantification of inflammation, with no need to normalize measurements.
• A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.
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Metadata
Title
Lights and shadows of cardiac magnetic resonance imaging in acute myocarditis
Authors
Antonio Esposito
Marco Francone
Riccardo Faletti
Maurizio Centonze
Filippo Cademartiri
Iacopo Carbone
Roberto De Rosa
Ernesto Di Cesare
Ludovico La Grutta
Guido Ligabue
Luigi Lovato
Erica Maffei
Riccardo Marano
Massimo Midiri
Gianluca Pontone
Luigi Natale
Francesco De Cobelli
From the Working Group of the Italian College of Cardiac Radiology by SIRM
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 1/2016
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-015-0444-7

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