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Correspondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis

2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 19 Linguagem: Inglês

10.1161/circulationaha.106.636639

1524-4539

Alban Redheuil, Arshid Azarine, P. Garrigoux, Élie Mousseaux,

Infectious Diseases and Tuberculosis

HomeCirculationVol. 114, No. 19Correspondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBCorrespondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis Alban B. Redheuil, MD, Arshid Azarine, MD, Pierre Garrigoux, MD and Elie Mousseaux, MD, PhD Alban B. RedheuilAlban B. Redheuil From Université Paris-Descartes, APHP, Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou (A.B.R., A.A., P.G., E.M.), and INSERM U678 (A.B.R., E.M.), Paris, France. , Arshid AzarineArshid Azarine From Université Paris-Descartes, APHP, Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou (A.B.R., A.A., P.G., E.M.), and INSERM U678 (A.B.R., E.M.), Paris, France. , Pierre GarrigouxPierre Garrigoux From Université Paris-Descartes, APHP, Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou (A.B.R., A.A., P.G., E.M.), and INSERM U678 (A.B.R., E.M.), Paris, France. and Elie MousseauxElie Mousseaux From Université Paris-Descartes, APHP, Department of Cardiovascular Radiology, Hôpital Européen Georges Pompidou (A.B.R., A.A., P.G., E.M.), and INSERM U678 (A.B.R., E.M.), Paris, France. Originally published7 Nov 2006https://doi.org/10.1161/CIRCULATIONAHA.106.636639Circulation. 2006;114:e571–e572A 42-year-old man who was an active smoker with no significant medical history presented with severe substernal pain 5 days after acute enteritis. The examination showed mild fever, blood pressure of 113/75 mm Hg, and heart rate of 85 beats per minute.The ECG showed sinus rhythm with incomplete left bundle-branch block. Laboratory tests showed elevated levels of troponin I (23 μg/L) and C-reactive protein (104 mg/L). Chest radiography was normal. Echocardiography showed subnormal left ventricular ejection fraction, mild global hypokinesia, and no pericardial effusion. ECG-gated, contrast-enhanced, 64-row multislice computed tomography (MSCT) showed normal coronary arteries and cine studies showed apical and lateral hypokinesia. A delayed acquisition performed 5 minutes after injection showed on 2.5-mm reformat images epicardial delayed enhancement (DE) of the lateral wall at the mid-left ventricle and basal levels and intramural and epicardial hyperenhancement of the apex (Figure, A and C). Download figureDownload PowerPointFive-cavity views in MSCT (A) and DE-MRI (B) show matching epicardial lateral (arrowheads) and intramural apical (arrows) delayed hyperenhancement. Apical short-axis views in MSCT (C) and DE-MRI (D) show matching epicardial and intramural delayed hyperenhancement (arrows).Magnetic resonance imaging (MRI) was performed to confirm myocardial DE. Cine-MRI confirmed the loco-regional contraction anomalies; left ventricular ejection fraction was 40%. DE-MRI studies (10 minutes after gadolinium diethylenetriamine pentaacetic acid injection) confirmed the delayed-enhancement findings seen on MSCT with better contrast but with an excellent topographic match (Figure, B and D). No subendocardial DE was seen. Absence of involvement of the subendocardium, patchy distribution of DE in MRI, and normal coronary arteries on computed tomography (CT) led to the diagnosis of acute left ventricular myocarditis.Although the usefulness of DE-MRI in the diagnosis of myocarditis has been well documented in the literature, similar DE areas seen on a delayed CT acquisition and compared with MRI had yet to be reported. The combination of coronary angiography and delayed myocardial imaging with CT in an emergency setting could be an alternative for the diagnosis of acute myocarditis that remains to be evaluated.DisclosuresNone.FootnotesCorrespondence to Alban Redheuil, MD, MSc, Cardiovascular Imaging Department, European Hospital, Georges Pompidou, University of Paris, René Descartes School of Medicine, 22, Rue Leblanc, 75908, Paris Cedex 15, France. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Karashima C, Fujimoto N, Yonezu K and Takahashi N (2022) Fulminant myocarditis spreading from the right ventricle treated with extracorporeal membrane oxygenation and impella, BMJ Case Reports, 10.1136/bcr-2021-247753, 15:5, (e247753), Online publication date: 1-May-2022. Cau R, Bassareo P, Mannelli L, Suri J and Saba L (2020) Imaging in COVID-19-related myocardial injury, The International Journal of Cardiovascular Imaging, 10.1007/s10554-020-02089-9, 37:4, (1349-1360), Online publication date: 1-Apr-2021. Kociol R, Cooper L, Fang J, Moslehi J, Pang P, Sabe M, Shah R, Sims D, Thiene G and Vardeny O (2020) Recognition and Initial Management of Fulminant Myocarditis, Circulation, 141:6, (e69-e92), Online publication date: 11-Feb-2020. 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Westenbrink B, de Boer R, Voors A, van Gilst W and van Veldhuisen D (2008) Anemia in chronic heart failure: etiology and treatment options, Current Opinion in Cardiology, 10.1097/HCO.0b013e3282f43025, 23:2, (141-147), Online publication date: 1-Mar-2008. Boussel L, Gamondes D, Staat P, Elicker B, Revel D and Douek P (2008) Acute Chest Pain With Normal Coronary Angiogram, Journal of Computer Assisted Tomography, 10.1097/RCT.0b013e3181452199, 32:2, (228-232), Online publication date: 1-Mar-2008. November 7, 2006Vol 114, Issue 19 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.636639PMID: 17088468 Originally publishedNovember 7, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)Imaging