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Contribution of Imaging in Myocarditis: Current and Upcoming Status
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Contribution of Imaging in Myocarditis: Current and Upcoming Status

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 5221

Special Issue Editor

Dr. Salim Si-Mohamed

E-Mail Website
Guest Editor
1. Department of cardiovascular and thoracic radiology, Louis Pradel Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
2. CREATIS, UMR 5220, Univ Lyon, INSA Lyon, University Claude Bernard Lyon 1, Lyon, France
Interests: cardiovascular disease; thoracic disease; spectral CT; computed tomography; photon-counting CT; dual-energy CT; magnetic resonance imaging

Special Issue Information

Dear Colleagues,

Myocarditis is a myocardial disease that is difficult to diagnose positively, etiologically, prognostically, and pre-therapeutically.

In recent years, numerous advances in imaging have allowed physicians to shed light on different aspects of this disease, from a diagnostic to a prognostic approach. This enabled improvements in diagnosis in the absence of the reference method of myocardial biopsy, as well as the proposal of a prognostic approach in the acute and remote phases. This is notably the case of the new parametric sequences in MRI and the emergence of the dual energy spectral scanner with the introduction of the extracellular volume in MRI and CT.

However, many questions remain concerning the characterization of the damage, the risk of recurrence, and the short- and long-term therapeutic management using modality imaging. This is the case, for example, in myocarditis induced by immunotherapy or those encountered during viral or autoimmune inflammatory processes, opening up a real clinical challenge.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Recent and new techniques in MRI for myocarditis
  • Recent and new techniques in CT, spectral CT for myocarditis
  • Recent and new techniques in PET-MRI, PET-CT for myocarditis
  • Diagnostic and prognostic performances of imaging modalities
  • Management guided by medical imaging

Dr. Salim Si-Mohamed
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • myocarditis
  • imaging modality
  • spectral CT
  • magnetic resonance imaging
  • diagnosis
  • prognosis

Published Papers (3 papers)

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Research

12 pages, 2943 KiB  
Article
Prognostic Significance of Cardiac Magnetic Resonance in Left Atrial and Biventricular Strain Analysis during the Follow-Up of Suspected Myocarditis
by Yan Chen, Wenjing Zhao, Nan Zhang, Jiayi Liu, Dongting Liu, Zhonghua Sun, Lei Xu and Zhaoying Wen
J. Clin. Med. 2023, 12(2), 457; https://doi.org/10.3390/jcm12020457 - 06 Jan 2023
Cited by 6 | Viewed by 1286
Abstract
To assess the variation in left atrial (LA) and biventricular strain and its prognostic value in the course of suspected myocarditis, this retrospective study included 55 patients with clinically suspected myocarditis who underwent cardiac magnetic resonance (CMR) examinations at baseline and follow-up periods. [...] Read more.
To assess the variation in left atrial (LA) and biventricular strain and its prognostic value in the course of suspected myocarditis, this retrospective study included 55 patients with clinically suspected myocarditis who underwent cardiac magnetic resonance (CMR) examinations at baseline and follow-up periods. Cine images were used for feature tracking analysis. Paired Student’s t test, McNemar’s test, and Cox proportional hazard regression were used for statistical analysis. The LA total emptying fraction was the only functional index that showed a statistically significant improvement. The initial LA peak’s late negative strain rate (SRa) was the only parameter with a significant predictive power of major adverse cardiac events under univariable (hazard ratio [HR] 2.396, 95% confidence interval [CI] 1.044–5.498, p = 0.039) and multivariable Cox survival analysis when adjusted by LA strain parameters (HR 5.072, 95% CI 1.478–17.404, p = 0.010), LA strain and functional parameters (HR 7.197, 95% CI 1.679–30.846, p = 0.008), and LA and biventricular strain and functional parameters (HR 10.389, 95% CI 2.250–47.977, p = 0.003). Thus, our findings indicate that CMR strain is useful for monitoring LA and ventricular function in suspected myocarditis, that LA function may recover preceding ventricular function changes, and that LA strain may serve as an incremental tool to predict adverse outcomes. Full article
(This article belongs to the Special Issue Contribution of Imaging in Myocarditis: Current and Upcoming Status)
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13 pages, 1990 KiB  
Article
Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis
by Jan M. Brendel, Karin Klingel, Jens Kübler, Karin A. L. Müller, Florian Hagen, Meinrad Gawaz, Konstantin Nikolaou, Simon Greulich and Patrick Krumm
J. Clin. Med. 2022, 11(17), 5113; https://doi.org/10.3390/jcm11175113 - 30 Aug 2022
Cited by 3 | Viewed by 1793
Abstract
(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR [...] Read more.
(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. (3) Methods: 48 patients (age 37 (IQR 28–55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (n = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (n = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T1, ECV, T2). (4) Results: Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T1 mapping (applying a segmental or global increase of native T1 > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T2 (AUC 0.66). (5) Conclusions: A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T1 mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings. Full article
(This article belongs to the Special Issue Contribution of Imaging in Myocarditis: Current and Upcoming Status)
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14 pages, 3536 KiB  
Article
Using Multiparametric Cardiac Magnetic Resonance to Phenotype and Differentiate Biopsy-Proven Chronic from Healed Myocarditis and Dilated Cardiomyopathy
by Patrick Krumm, Jan M. Brendel, Karin Klingel, Karin A. L. Müller, Jens Kübler, Christoph Gräni, Meinrad Gawaz, Konstantin Nikolaou and Simon Greulich
J. Clin. Med. 2022, 11(17), 5047; https://doi.org/10.3390/jcm11175047 - 28 Aug 2022
Cited by 2 | Viewed by 1687
Abstract
(1) Objectives: To discriminate biopsy-proven myocarditis (chronic vs. healed myocarditis) and to differentiate from dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR). (2) Methods: A total of 259 consecutive patients (age 51 ± 15 years; 28% female) who underwent both endomyocardial [...] Read more.
(1) Objectives: To discriminate biopsy-proven myocarditis (chronic vs. healed myocarditis) and to differentiate from dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR). (2) Methods: A total of 259 consecutive patients (age 51 ± 15 years; 28% female) who underwent both endomyocardial biopsy (EMB) and CMR in the years 2008–2021 were evaluated. According to right-ventricular EMB results, patients were divided into either chronic (n = 130, 50%) or healed lymphocytic myocarditis (n = 60, 23%) or DCM (n = 69, 27%). The CMR protocol included functional, strain, and late gadolinium enhancement (LGE) imaging, T2w imaging, and T2 mapping. (3) Results: Left-ventricular ejection fraction (LV-EF) was higher, and the indexed end-diastolic volume (EDV) was lower in myocarditis patients (chronic: 42%, median 96 mL/m²; healed: 49%, 86 mL/m²) compared to the DCM patients (31%, 120 mL/m²), p < 0.0001. Strain analysis demonstrated lower contractility in DCM patients vs. myocarditis patients, p < 0.0001. Myocarditis patients demonstrated a higher LGE prevalence (68% chronic; 59% healed) than the DCM patients (45%), p = 0.01. Chronic myocarditis patients showed a higher myocardial edema prevalence and ratio (59%, median 1.3) than healed myocarditis (23%, 1.3) and DCM patients (13%, 1.0), p < 0.0001. T2 mapping revealed elevated values more frequently in chronic (90%) than in healed (21%) myocarditis and DCM (23%), p < 0.0001. T2 mapping yielded an AUC of 0.89 (sensitivity 90%, specificity 76%) in the discrimination of chronic from healed myocarditis and an AUC of 0.92 (sensitivity 86%, specificity 91%) in the discrimination of chronic myocarditis from DCM, both p < 0.0001. (4) Conclusions: Multiparametric CMR imaging, including functional parameters, LGE and T2 mapping, may allow differentiation of chronic from healed myocarditis and DCM and therefore help to optimize patient management in this clinical setting. Full article
(This article belongs to the Special Issue Contribution of Imaging in Myocarditis: Current and Upcoming Status)
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