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J Am Coll Cardiol. 2018 Dec 18;72(24):3158-3176. doi: 10.1016/j.jacc.2018.09.072.

Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations.

Author information

1
University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, United Kingdom.
2
Charité-Universitätsmedizin, Department of Cardiology and Helios-Klinikum, DZHK-Partnersite-Berlin, Germany.
3
Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
4
Departments of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, Virginia.
5
Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy.
6
Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
7
Department of Internal Medicine III, Saarland University Medical Center, Homburg/Saar, Germany.
8
Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany.
9
Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
10
Ottawa Heart Institute, Ottawa, Canada.
11
Heidelberg University Hospital, Heidelberg, Germany; Department of Cardiology, McGill University Health Centre, Montreal, Canada; Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada. Electronic address: mgwfriedrich@gmail.com.

Abstract

This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.

KEYWORDS:

cardiovascular magnetic resonance; myocardial inflammation; myocarditis

PMID:
30545455
DOI:
10.1016/j.jacc.2018.09.072

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