From Franz-Volhard-Klinik am Max Delbrück Centrum für
Molekulare Medizin, Virchow Klinikum, Humboldt Universität zu Berlin, and
the Institut für Diagnostische Radiologie, Städtisches Klinikum
Berlin-Buch (H.M.), Germany.
Correspondence to Matthias G. Friedrich, MD, Franz-Volhard-Klinik, Wiltbergstr 50, 13122 Berlin, Germany. E-mail friedrich{at}fvk-berlin.de
Background—The course of tissue
changes in acute myocarditis in humans is not well understood.
Diagnostic tools currently available are unsatisfactory. We
tested the hypothesis that inflammation is reflected by signal changes
in contrast-enhanced magnetic resonance imaging (MRI).
Methods and Results—We assessed 44 consecutive patients with
symptoms of acute myocarditis. Nineteen patients met the inclusion
criteria revealing ECG changes, reduced myocardial function, elevated
creatine kinase, positive troponin T, serological evidence for acute
viral infection, exclusion of coronary heart disease, and
positive antimyosin scintigraphy. We studied these patients
on days 2, 7, 14, 28, and 84 after the onset of symptoms. We obtained
ECG-triggered, T1-weighted images before and after application of
0.1 mmol/kg gadolinium. We measured the global relative signal
enhancement of the left ventricular myocardium
related to skeletal muscle and compared it with measurements in 18
volunteers. The global relative enhancement was higher in patients on
days 2 (4.8±0.3 [mean±SE] versus 2.5±0.2;
P<.0001); 7 (4.7±0.5, P<.0001); 14
(4.6±0.5, P<.0002); and 28 (3.9±0.4,
P=.009) but not on day 84 (3.1±0.3;
P=NS). On day 2, the enhancement was focal, whereas at
later time points, the enhancement was diffuse. In patients with
evidence of ongoing disease, the values remained elevated.
Conclusions—Acute myocarditis evolves from a focal to a
disseminated process during the first 2 weeks after onset of symptoms.
Contrast media–enhanced MRI visualizes the localization, activity, and
extent of inflammation and may serve as a powerful noninvasive
diagnostic tool in acute myocarditis.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Contrast Media–Enhanced Magnetic Resonance Imaging Visualizes Myocardial Changes in the Course of Viral Myocarditis
Key Words: myocarditis • magnetic resonance imaging • contrast media
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