Myocarditis: imaging up to date
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CARDIAC RADIOLOGY
Myocarditis: imaging up to date Carlo Liguori1 · Davide Farina2 · Filippo Vaccher2 · Giovanni Ferrandino3 · Davide Bellini4 · Iacopo Carbone4 Received: 22 June 2020 / Accepted: 3 September 2020 / Published online: 6 October 2020 © The Author(s) 2020
Abstract Myocarditis is an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria. Endomyocardial biopsy represents the diagnostic gold standard for its diagnosis but is infrequently used. Due to its noninvasive ability to detect the presence of myocardial edema, hyperemia and necrosis/fibrosis, Cardiac MR imaging is routinely used in the clinical practice for the diagnosis of acute myocarditis. Recently pixel-wise mapping of T1 and T2 relaxation time have been introduced into the clinical Cardiac MR protocol increasing its accuracy. Our paper will review the role of MR imaging in the diagnosis of acute myocarditis. Keywords Myocarditis · Myocardial inflammation · Cardiac MR · Magnetic resonance imaging
Introduction In 1995 the World Health Organization (WHO)/International Society and Federation of Cardiology (ISFC) defined myocarditis as an inflammatory disease of the heart muscle, diagnosed by histological, immunological, and immunohistochemical criteria [1]. Myocarditis diagnosis is often challenging because of the heterogeneity of clinical presentations. The real incidence of myocarditis is difficult to work out as endomyocardial biopsy (EMB), the diagnostic gold standard, is employed infrequently [1–3]. Several published studies report a highly variable autopsy prevalence of myocarditis (2–42%). Thanks to its unique ability to directly image myocardial necrosis, fibrosis and edema, cardiac magnetic resonance
* Iacopo Carbone [email protected] 1
Radiology Unit, Ospedale del Mare- A.S.LNa1-Centro, 80147, Naples, Italy
2
Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia - ASST Spedali Civili of Brescia, Brescia, Italy
3
Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
4
Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, I.C.O.T. Hospital, Via Franco Faggiana1668, 04100 Latina, LT, Italy
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(CMR) is now considered the first tool for noninvasive assessment of patients with suspected myocarditis. CMR is also useful for monitoring disease activity under treatment [4]. Myocarditis clinical resolution is often spontaneous in patients presenting with mild symptoms, even if in presence of minimal ventricular dysfunction. However, in up to 30% of cases, biopsy-proven myocarditis can progress to dilated cardiomyopathy (DCM) [5]. CMR plays a role in the follow-up of such cases to detect the progression toward a dilatative phenotype [4]. The underlying etiology determines a patient prognosis variation. In several myocarditis forms, a symptomatic treatment is sufficient but immunohistochemical and mol
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