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CMR in Myocarditis: Diagnosis, Treatment Evaluation and Outcome

Moderated by Cristina Basso and Marco Francone

CMR imaging of myocardial inflammation is one of the most commonly addressed clinical indication  to the exam and a topic of intensive scientific research all over the world. 

The method became a primary diagnostic tool in this clinical setting, due to its unique potential to comprehensively characterize the various morphological and functional changes of myocardial inflammation with relevant impact on patient’s management and prognosis. 

More recently, availability and validation of T1 and T2 mapping-sequences, allowed a further expansion of clinical applications in myocarditis, moving from the semiquantitative diagnostic approach derived from conventional-imaging (the so-called Lake Louse Criteria) towards a pure quantitative assessment of tissue abnormalities, based on myocardial relaxation changes measurements.

This brought the possibility of exhaustively exploring different phases of myocardial inflammation, from the diagnosis towards the follow-up of therapeutic response and evaluation of patient’s outcome, which have been explored a in this special session of the this meeting.

Dr. Greulich from Tübingen opened the sessions focusing on the importance of clinical manifestations for correct patient’s selection.   “Syndromic” manifestations of the disease were presented and their potential related impact on CMR accuracy in different clinical scenarios. He showed importance of CMR imaging in different clinical settings emphasizing its primary role for diagnosis and prognostic stratification and suggested that the examinations should be systematically performed in all patient.

Second lecture of Dr. Garot, from Massy, aimed to clarify wether use of  CMR in Myocarditis had been supported by enough evidence for clinical practice. He analyzed natural history of the disease which may run asymptomatic and heal without squeale or evolve towards development of chronic persistent forms potentially leading to dilated cardiomyopathy.

Final lecture of Dr. Francone addressed a specific acquisition issue regarding utilization of mapping sequences in clinical practice as compared to conventional imaging based on Lake-Louse criteria. 

Analyzing recently published large prospective trials, he concluded that T1- and T2-Mapping provide lower intra- and interobserver variability than Lake-Louse criteria. Relaxometry-imaging should be implemented in routine protocols, particularly in patients with mild forms of disease of with diffuse myocardial involvement, in which conventional imaging sequences may miss subtle tissue intensity changes.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.