The added value of cardio-rm in patients with suspected myocarditis. Poster No.: C-0189 Congress: ECR 2015 Type: Scientific Exhibit Authors: E. Chiodi 1, M. T. Cannizzaro 1, B. Malta 1, C. Montalto 1, Z. Ferrante 1, M. Natali 1, V. Positano 2, M. Giganti 1, G. Benea 1 ; 1 Ferrara/IT, 2 Pisa/IT Keywords: DOI: Cardiac, Computer applications, Cardiovascular system, MR, Diagnostic procedure, Imaging sequences, Ischemia / Infarction 10.1594/ecr2015/C-0189 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Aims and objectives The aim of this study is to test the added value of cardio-rm in the diagnostic classification and in the clinical management of patients suspected for myocarditis,through the use of standardized protocol aimed to assess global and segmental kinetics, edema and delayed enhancement. The main acute myocardial diseases are three: myocardial infarction; Takotsubo; inflammatory disease such as myocarditis. Methods and materials In this retrospective study we performed cardiac MRI in 41 patients (32 males, 9 females, p=0.0006, age: 47 ± 17 years) suspected for acute myocarditis. Images for this section: Fig. 1: 41 patients: 32 males, 9 females Page 2 of 7
Results All patients performed precontrast SSFP sequences to obtain the quantitative measurement of the left ventricular function. BBT2 sequences were performed on all patients and myocardial edema was detected in 27 patients. Modified SSFP sequence was performed on all patients, of which 20 positively evaluated for presence of myocardial damage. IRGE sequences were acquired in all patients, with areas of DE detected in 33 patients. On 33 patients with a positive delayed enhancement (DE), 5 had an ischemic pattern. Remaining 28 patients had predominantly a subepicardial pattern, septal less frequently, however a myocarditis localization. 8 patients negative for DE: 2 patients were negative for edema showed kinetics typical picture of Tako-tsubo, 2 patients had supepicardial edema in T2 FAT-SAT suspecting for myocarditis, and finally in the remaining 4 patients MRI did not provide useful information for clinical management. Furthermore, the ejection fraction is lower in patients with edema with statistical significance at the limit, and does not depend significantly by the presence of DE. Images for this section: Fig. 2: Delayed enhancement percentage Page 3 of 7
Fig. 3: Non ischemic delayed versus edema Page 4 of 7
Fig. 4: Final results Page 5 of 7
Conclusion The cardiac MR, used to study the acute non-ischemic heart disease, is a tool of great importance for the diagnosis and the clinical management, but it is essential to identify an optimal protocol sequences MRI. Personal information Dr. Chiodi Elisabetta 1, Dr. Cannizzaro Maria Teresa 1, Dr. Malta Bruna 2, Dr. Montalto Clorinda 2, Dr. Ferrante Zairo 2, Dr. Natali Marcello 2, Dr. Positano Vincenzo 3, Dir. Giganti Melchiore 2, Dir. Benea Giorgio 1. 1) Radiology University - Department of Diagnostic Imaging and Laboratory Medicine, University of Ferrara (Director: Prof. Melchiore Giganti), Nuovo Arcispedale Sant'Anna, Cona (Ferrara), ITALY. 2) Hospital Radiology - Diagnostic image and Laboratory Medicine, Sant'Anna Hospital, Ferrara (Director: Dr. Giorgio Benea), ITALY. 3) G. Monasterio CNR Foundation - Regione Toscana e Istituto di Fisiologia Clinica, Pisa, ITALY. References Friedrich MG, Strohm O, Schulz-Menger J, Marciniak H, Luft FC, Dietz R (1998) Contrast-enhanced magnetic resonance imaging visualizes changes in the course of viral myocarditis. Circulation 97:1802-1809 Friedrich MG, Sechtem I, Schulz-Menger J et al (2009) Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 53:1475-1487. De Cobelli F; Natale L Risonanza magnetica cardiaca Malattie infiammatorie del miocardio pag 157-164,Springer, 2010. Page 6 of 7
Hombach V, Merkle H N., KestlerJan et Al Characterization of patients with acutechest pain using cardiac magnetic resonance imaging Clin Res Cardiol 97:760-767,2008. Page 7 of 7