Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Roessler, P.
Comparison of cardiac MRI and endomyocardial biopsy in the diagnosis of myocarditis
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2024. pp. 82
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Rainer Peter
- Schmid Johannes
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- Abstract:
- Introduction Cardiac MRI and endomyocardial biopsy represent the current noninvasive and invasive gold standard of myocarditis-diagnosis. We aimed to investigate the diagnostic concordance of endomyocardial biopsy and cardiac MRI in the diagnosis of myocarditis. In the sub analysis, we investigated whether performing endomyocardial biopsy prior to cardiac MRI leads to an increased number of false-positive myocarditis diagnoses. Methods We performed a retrospective data analysis. One hundred sixty-six patients were included in our main analysis who received biopsy and MRI in a time frame of 30 days between 2008 and 2020 at our university clinic. For the sub analysis we included 147 patients who received both investigations within 14 days. The patients were divided into the groups 'biopsy before MRI' and 'MRI before biopsy'. We compared the groups regarding the occurrence of Lake Louise myocarditis criteria and MRI myocarditis diagnoses and calculated the positive predictive value (PPV) and negative predictive value (NPV) for the MRI with biopsy-confirmed myocarditis as a reference. Results In our main analysis 119 (72%) patients were diagnosed with myocarditis in either biopsy or MRI. In the MRI reports, 61 (37%) patients were diagnosed with myocarditis, compared to 101 (61%) inflammatory cardiomyopathy diagnoses in EMB reports. In 90 (54%) patients, a concordant diagnosis was made in biopsy and MRI with regard to the question of whether myocarditis was present or absent. Comparing groups in our sub analysis, frequency of detected non-ischemic LGE (60.0% versus 73.9%, p=0.078) and edema (16.4% vs. 24.4%, p=0.249) was not significantly different. In group ‘biopsy before MRI’ (n=55), 92% of MRI-suspected myocarditis cases were concordantly diagnosed with myocarditis in their biopsy reports with a NPV and PPV of 42.9% and 92.3%. In contrast, in group ‘MRI before biopsy’ (n=92) only 60% of MRI-suspected myocarditis cases were concordantly diagnosed in their biopsy reports with a NPV and PPV of 42.3% and 60.0%. Conclusio We found moderate concordance of MRI and endomyocardial biopsy in the diagnosis of myocarditis. Performing endomyocardial biopsy prior to cardiac MRI did neither result in increased incidences of nonischemic late gadolinium enhancement or myocardial edema, nor did it result in an increase of false-positive diagnoses of myocarditis in MRI.