A novel multiparametric imaging approach to acute myocarditis using T2-mapping and CMR feature tracking

Background: the aim of this study was to evaluate the diagnostic potential of a novel cardiovascular magnetic resonance (cmr) based multiparametric imaging approach in suspected myocarditis and to compare it to traditional lake louise criteria (llc). methods: cmr data from 67 patients with suspected acute myocarditis were retrospectively analyzed. seventeen age- and gender-matched healthy subjects served as control. t2-mapping data were acquired using a gradient-spin-echo t2-mapping sequence in short-axis orientation. t2-maps were segmented according to the 16-segments aha-model and segmental t2 values and pixel-standard deviation (sd) were recorded. afterwards,the parameters maxt2 (the highest segmental t2 value) and madsd (the mean absolute deviation (mad) of the pixel-sds) were calculated for each subject. cine sequences in three long axes and a stack of short-axis views covering the left and right ventricle were analyzed using a dedicated feature tracking algorithm. results: a multiparametric imaging model containing madsd and lv global circumferential strain (gcslv) resulted in the highest diagnostic performance in receiver operating curve analyses (area under the curve [auc] 0.84) when compared to any model containing a single imaging parameter or to llc (auc 0.79). adding late gadolinium enhancement (lge) to the model resulted in a further increased diagnostic performance (auc 0.93) and yielded the highest diagnostic sensitivity of 97% and specificity of 77%. conclusions: a multiparametric cmr imaging model including the novel t2-mapping derived parameter madsd,the feature tracking derived strain parameter gcslv and lge yields superior diagnostic sensitivity in suspected acute myocarditis when compared to any imaging parameter alone and to llc. © 2017 the author(s).