BACKGROUND Myocardial T1 and T2 mapping are reliable diagnostic markers for the detection and follow up of acute myocarditis. The aim of this study was to compare the diagnostic performance of current mapping measurement approaches to differentiate between myocarditis patients and healthy individuals. METHODS Fifty patients with clinically defined acute myocarditis and 30 healthy controls underwent cardiovascular magnetic resonance (CMR). Myocardial T1 relaxation times, T2 relaxation times, left ventricular (LV) function, T2 ratio, early gadolinium enhancement ratio, and presence of late gadolinium enhancement (LGE) were analysed. Native T1 and T2 relaxation times, as well as extracellular volume fraction (ECV) were measured for the entire LV myocardium (global), within the midventricular short axis slice (mSAX), within the midventricular septal wall (ConSept), and within the remote myocardium (remote). Receiver operating characteristics analysis was performed to compare diagnostic performance. RESULTS All measurement approaches revealed significantly higher native T1 and T2 relaxation times as well as ECV values in patients compared to healthy controls (p < 0.05 for all parameters). The global measurement approach showed highest diagnostic performance regarding all mapping parameters (AUCs, native T1: 0.903, T2: 0.847, ECV: 0.731). Direct comparison of the different measurement approaches revealed significant differences in diagnostic performance between the global and the remote approach regarding T1 relaxation times and ECV (p = 0.001 and p = 0.002 respectively). Further, the global measurement approach revealed significantly higher T1 relaxation times compared to the ConSept approach (AUCs: 0.903 vs. 0.783; p = 0.003) and nearly significant differences compared to the mSAX approach (AUC: 0.850; p = 0.051). T2 relaxation times showed no significant differences between all measurement approaches (p > 0.050 for all parameters). CONCLUSIONS Native T1 and T2 mapping allow for accurate detection of acute myocarditis irrespective of the measurement approach used. Even measurements performed exclusively within remote myocardium allow for reliable detection of acute myocarditis, demonstrating diffuse involvement of disease despite a mostly regional or patchy distribution pattern of visible pathologies. The global measurement approach provides the overall best diagnostic performance in acute myocarditis for both T1 and T2 mapping.

中文翻译：

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急性心肌炎的多参数心血管磁共振成像：不同测量方法的比较。

背景技术心肌T1和T2作图是用于急性心肌炎的检测和随访的可靠诊断标记。这项研究的目的是比较当前作图测量方法的诊断性能，以区分心肌炎患者和健康个体。方法对50例临床上明确的急性心肌炎患者和30名健康对照者进行了心血管磁共振（CMR）。分析了心肌的T1弛豫时间，T2弛豫时间，左心室（LV）功能，T2比，early早期增强率和晚期enhancement增强（LGE）的存在。在心室中短轴切片（mSAX）内测量整个LV心肌（整体）的原始T1和T2弛豫时间，以及细胞外体积分数（ECV），在室间隔中壁内（ConSept），以及在远端心肌内（远端）。进行接收器工作特性分析以比较诊断性能。结果与健康对照组相比，所有测量方法均显示患者的天然T1和T2弛豫时间以及ECV值均显着提高（所有参数的p <0.05）。对于所有映射参数（AUC，本机T1：0.903，T2：0.847，ECV：0.731），全局测量方法显示出最高的诊断性能。对不同测量方法的直接比较显示，总体方法和远程方法在T1弛豫时间和ECV方面的诊断性能存在显着差异（分别为p = 0.001和p = 0.002）。进一步，与ConSept方法相比（AUCs：0.903对0.783； p = 0.003），整体测量方法显示T1弛豫时间明显更长；与mSAX方法（AUC：0.850; p = 0.051）相比，T1弛豫时间明显更长。T2弛豫时间在所有测量方法之间均无显着差异（对于所有参数，p> 0.050）。结论无论采用何种测量方法，本机T1和T2定位都可以准确检测急性心肌炎。即使仅在遥远的心肌内进行测量，也可以可靠地检测出急性心肌炎，尽管可见病理的局部或局部分布模式，也证明了疾病的弥漫性累及。