Matthias Gutberlet MD, Presenter: Nothing to Disclose

Birgit Spors MD, Abstract Co-Author: Nothing to Disclose

Tobias Thoma, Abstract Co-Author: Nothing to Disclose

Roland Felix MD, PhD, Abstract Co-Author: Nothing to Disclose

Sebastian Mehl MD, Abstract Co-Author: Nothing to Disclose

Heinz-Peter Schultheiss MD, Abstract Co-Author: Nothing to Disclose

Uwe Kuehl MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The diagnostic value of MRI in biopsy-proven virus-associated chronic myocardial inflammation has not yet been established. Viral infection and inflammatory processes of the myocardium can become chronic with virus persistence. Today, diagnosis is routinely established by histological, immunohistological and molecular biological analysis of endomyocardial biopsies (EMB).

Cardiovascular MRI was performed in 83 patients, 49 with proven cardiotropic viral persistence in EMB and 34 without viral persistence as controls. Different MR sequences were used: STIR-, T2- and T1-weighted FSE images before and after contrast agent administration to assess myocardial edema and inflammation as well as inversion recovery gradient-echo and steady-state free-precession sequences to assess myocardial fibrosis and function.

Thirty-nine patients had a single virus infection, and 10 a double infection. Edema (ER) was present in 51% overall (virus-positive: 51%; virus-negative: 53%), and increased global relative enhancement (gRE) indicating active inflammation in 42% (51%/29%). gRE correlated well with the results of EBM, detecting inflammation in 58% (61%/53%). In 23% (25%/24%) of the patients late gadolinium enhancement (LE) was demonstrated to be an indicator for irreversibly injured myocardium. In comparison with immunohistological detection of inflammation ROC analysis showed the best AUC value for gRE (0.818) and ER (0.754).

In chronic myocarditis inflammation and therefore increased ER and gRE are common findings, but LE is less commonly detected than reported for acute myocarditis. These sequences may be helpful to distinguish between persisting inflammation and irreversibly injured myocardium, but cannot replace EMB for the initial detection of viral persistence.

To differentiate between patients with persisting inflammation and/or scar tissue in chronic myocarditis to predict prognosis and to guide therapy or further diagnostics.

Gutberlet, M, Spors, B, Thoma, T, Felix, R, Mehl, S, Schultheiss, H, Kuehl, U, et al, , Multisequential Cardiac MRI in Patients with Biopsy-proven Myocarditis associated with Persistent Chronic Virus and in Virus-negative Controls.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4440299.html