ISSN 2996-8215
International Journal of Cardiology | Vol. 6, No. 5, May 2015 | pp. 33–40
DOI: 10.46882/2015/IJC/000074
Review Article
The Growing Role of Advanced Cardiac Magnetic Resonance Parametric Mapping in Evaluating Myocarditis
Sarah L. Jenkins¹, David M. Ross²
¹Department of Cardiovascular Sciences, British Heart Foundation Centre, King's College London, London, United Kingdom
²Division of Cardiology, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
Abstract:
Acute myocarditis presents with highly variable clinical phenotypes, complicating definitive diagnostic stratification. Traditional cardiac magnetic resonance (CMR) imaging pathways relying on the Lake Louise Criteria offer reasonable diagnostic accuracy but lack sensitivity for diffuse interstitial changes or subtle inflammatory resolution tracking. This systematic review synthesizes recent clinical data regarding the utility of quantitative CMR parametric T1 and T2 mapping methods for diagnosing and monitoring suspected acute myocarditis. A comprehensive database search identified 34 clinical trials involving a combined sample of 2,840 individuals. Quantitative T2 mapping holds exceptional accuracy for detecting localized myocardial edema, showing a pooled sensitivity of 88.0% (95% CI: 83.2%–91.8%) and a specificity of 91.2% (95% CI: 86.5%–94.7%) against endomyocardial biopsy findings. Native T1 mapping and calculated extracellular volume (ECV) fractions successfully quantify diffuse interstitial fibrosis and remodeling that occur secondary to continuous cellular inflammation. Elevated native T1 values provide an adjusted hazard ratio of 2.15 (95% CI: 1.42–3.26, p < 0.01) for predicting 6-month major adverse cardiovascular events (MACE). Quantitative T1 and T2 mapping techniques markedly enhance the diagnostic specificity of CMR for acute myocarditis, offering non-invasive markers to track active inflammatory expansion and refine clinical risk prediction.
Keywords: Myocarditis, Cardiac magnetic resonance, T1 mapping, T2 mapping, Extracellular volume fraction, Myocardial edema, Inflammation
Received: February 14, 2015; Revised: March 28, 2015; Accepted: April 15, 2015; Published: May 20, 2015