Assessment of Myocarditis: Cardiac MR, PET/CT, or PET/MR?

Journal Article · Thu Aug 15 04:00:00 EDT 2019 · Current Cardiology Reports (Print)

DOI:https://doi.org/10.1007/S11886-019-1158-0· OSTI ID:22929226

Chen, Wengen; Jeudy, Jean ^[1]

---

1. University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine (United States)

Purpose of Review: Diagnosis of myocarditis is challenging given its variable clinical manifestations and non-specific laboratory findings. Cardiac magnetic resonance (MR) is currently the preferred imaging modality for the diagnosis of myocarditis. {sup 18}F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT), as a functional imaging tool, has a potential role in the assessment of myocarditis by detecting the underlying myocardial inflammatory activity. Data are accumulating that simultaneous cardiac PET/MR may have complementary and incremental values for the evaluation of myocarditis compared to PET/CT or cardiac MR alone. The article aims to summarize the findings in the literature and discuss future directions of cardiac PET/MR for myocarditis. Recent Findings: The Lake Louis Criteria (CLL) of cardiac MR is widely used for the diagnosis of myocarditis. It has an overall acceptable sensitivity of 67% and specificity of 91% for acute myocarditis but does not have the same accuracy for chronic myocarditis. FDG PET/CT is capable of assessing myocarditis by providing metabolic information of inflammation as increased myocardial FDG uptake. In addition to reduced radiation exposure, FDG PET performed on a hybrid PET/MR may detect more myocarditis than FDG PET/CT, because of the delayed PET acquisition time on PET/MR. Case-based observations and small clinical studies of FDG PET/MR have shown that FDG PET findings as abnormally increased myocardial uptake correlate well with the cardiac MR biomarkers. FDG PET findings may add complementary and incremental values to cardiac MR by improving the sensitivity of cardiac MR for mild or borderline myocarditis, and increasing specificity for chronic myocarditis. Summary: Preliminary data from retrospective and case-based observational studies have suggested the complementary and incremental values of simultaneous cardiac FDG PET/MR for evaluation of myocarditis, compared to PET/CT or MR alone. Well-designed studies are needed to confirm the findings and to assess the value of cardiac PET/MR for clinical management and more importantly patient’s outcome in both acute and chronic myocarditis.

• OSTI ID: 22929226
• Journal Information: Current Cardiology Reports (Print), Journal Name: Current Cardiology Reports (Print) Journal Issue: 8 Vol. 21; ISSN 1523-3782
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIOLOGICAL MARKERS
CHEST
COMPARATIVE EVALUATIONS
DIAGNOSIS
FLUORINE 18
GLUCOSE
INFLAMMATION
NMR IMAGING
POSITRON COMPUTED TOMOGRAPHY
UPTAKE