Characterization of Benign Myocarditis Using Quantitative Delayed-Enhancement Imaging Based on Molli T1 Mapping

Abstract

Delayed contrast enhancement after injection of a gadolinium-chelate (Gd-chelate) is a reference imaging method to detect myocardial tissue changes. Its localization within the thickness of the myocardial wall allows differentiating various pathological processes such as myocardial infarction (MI), inflammatory myocarditis, and cardiomyopathies. The aim of the study was first to characterize benign myocarditis using quantitative delayed-enhancement imaging and then to investigate whether the measure of the extracellular volume fraction (ECV) can be used to discriminate between MI and myocarditis.In 6 patients with acute benign myocarditis (32.2 ± 13.8 year-old, subepicardial late gadolinium enhancement [LGE]) and 18 patients with MI (52.3 ± 10.9 year-old, subendocardial/transmural LGE), myocardial T1 was determined using the Modified Look-Locker Imaging (MOLLI) sequence at 3 Tesla before and after Gd-chelate injection. T1 values were compared in LGE and normal regions of the myocardium. The myocardial T1 values were normalized to the T1 of blood, and the ECV was calculated from T1 values of myocardium and blood pre- and post-Gd injection.In both myocarditis and MI, the T1 was lower in LGE regions than in normal regions of the left ventricle. T1 of LGE areas was significantly higher in myocarditis than in MI (446.8 ± 45.8 vs 360.5 ± 66.9 ms, P = 0.003) and ECV was lower in myocarditis than in MI (34.5 ± 3.3 vs 53.8 ± 13.0 %, P = 0.004).Both inflammatory process and chronic fibrosis induce LGE (subepicardial in myocarditis and subendocardial in MI). The present study demonstrates that the determination of T1 and ECV is able to differentiate the 2 histological patterns.Further investigation will indicate whether the severity of ECV changes might help refine the predictive risk of LGE in myocarditis.

FIGURE 1

Diastolic image of lateral subepicardial LGE (arrows) and corresponding T1 maps before and after gadolinium in myocarditis. IR-TFL = inversion recovery turbo FLASH; PSIR = phase-sensitive inversion recovery.

FIGURE 2

Diastolic image of inferior subendocardial LGE (arrows) and corresponding T1 maps before and after gadolinium in myocardial infarction. IR-TFL = inversion recovery turbo FLASH; PSIR = phase-sensitive inversion recovery.

FIGURE 3

(A) T1 LGE area/T1 blood values after Gd-DOTA for myocarditis (n = 6) and myocardial infarction (n = 18). Box and whisker plots show median, 25, and 75 percentiles and range. T1 of myocardium with LGE was significantly higher in myocarditis than in myocardial infarction (P = 0.008). (B) ECV values (%) for myocarditis (n = 6) and myocardial infarction (n = 18). ECV of myocardium with LGE was significantly lower in myocarditis than in myocardial infarction (P = 0.0001).