The value of dual-energy computed tomography in the evaluation of myocarditis

Abstract

Purpose: The inflammation of the heart muscle is referred to as acute myocarditis. Cardiac magnetic resonance imaging (CMR) has become the primary method for a non-invasive assessment of myocardial inflammation. However, there are several drawbacks of CMR. During the last decade, dual energy computed tomography (DECT) has been used in cardiac imaging. The current study aims to assess the efficacy and feasibility of DECT in acute myocarditis and compare the results to CMR.

Methods: This prospective study included patients who had myocarditis but no coronary artery pathology. Two observers evaluated the patients for acute myocarditis using DECT and CMR. CMR was performed on 22 patients within 24 hours of DECT, which was administered within 12 hours following the onset of chest pain. Inter-observer agreement was tested with Cohen's Kappa coefficient, and Spearman's correlation was used to examine the possible correlations. A P value of <0.050 was accepted as statistically significant.

Results: The DECT and CMR agreement was significant for transmural diagnoses, excellent for subepicardial and intramyocardial diagnoses, and perfect for nodular and band-like patterns.

Conclusion: The findings of this study showed that the dark areas on the color-coded iodine map created with DECT were strongly correlated with CMR in acute cases of myocarditis. In addition, DECT is a robust imaging method that can also be used in the diagnosis of acute myocarditis. Furthermore, it provides information about coronary arteries faster and more reliably than magnetic resonance imaging without any limitations.

Keywords: Dual-energy computed tomography; cardiac magnetic resonance imaging; magnetic resonance imaging; myocarditis.

Figure 1

The procedure of “DE normalize contrast” (indicated by arrows) in the iodine map on dual energy computed tomography using a dedicated workstation. DE, dual energy.

Figure 2

Nodular transmural involvement of acute myocarditis. The dark areas on the iodine map on the dual energy computed tomography image (thin arrows), the corresponding edema on the T2-weighted image (thick arrows), and hyperenhancement on the late gadolinium enhancement image (in the circle) in the cardiac magnetic resonance image.

Figure 3

Band-like intramyocardial involvement of acute myocarditis. The dark areas on the iodine map on the dual energy computed tomography image (long arrows), the corresponding edema on T2-weighted image (short arrows), and hyperenhancement on the late gadolinium enhancement image (in the circle with arrows) in the cardiac magnetic resonance image. The arrows indicate the band-like intramyocardial involvement of acute myocarditis.

Figure 4

Band-like subepicardial involvement of the lateral wall and nodular intramyocardial involvement of the septum of the left ventricle in acute myocarditis. The dark areas on the iodine map on the dual energy computed tomography (DECT) image (single long arrow), the corresponding edema on the T2-weighted image (double short arrow), and hyperenhancement on the late gadolinium enhancement (LGE) image (in the dark circle with arrows) in the cardiac magnetic resonance image (CMR) for nodular intramyocardial involvement of the septum of the left ventricle. The dark areas on the iodine map on the DECT image (multiple long arrows), the corresponding edema on the T2-weighted image (multiple short arrows), and hyperenhancement on the LGE image (in the white circle with arrows) in CMR for band-like subepicardial involvement of the lateral wall.