Giri Latika, Singh Roshan, Marey Ahmed, Li Yupeng, Venkatesh Bharath Ambale, Abdulla Jawdat, Zimmerman Stefan, Umair Muhammad
Department of Radiology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
J Cardiovasc Imaging. 2025 Jun 3;33(1):5. doi: 10.1186/s44348-025-00048-3.
Cardiovascular magnetic resonance mapping parameters-native T1 mapping, T2 mapping, and extracellular volume (ECV)-are key for diagnosing acute myocarditis under the modified 2018 Lake Louise Criteria (mLLC). This systematic review and meta-analysis evaluated their diagnostic performance and established optimal thresholds for acute myocarditis.
We reviewed articles published in the past decade utilizing parametric mapping for myocarditis diagnosis. Data on sensitivity, specificity, and area under the curve (AUC) were extracted. Quality assessment was conducted using the QUADAS-2 tool by two independent reviewers.
Eleven studies with 677 patients were included. Native T1 mapping showed sensitivity of 83%, specificity of 86%, diagnostic odds ratio (DOR) of 39, and an AUC of 0.91. T2 mapping had sensitivity of 81%, specificity of 86%, DOR of 25, and an AUC of 0.89. ECV demonstrated sensitivity of 71%, specificity of 81%, DOR of 13, and an AUC of 0.83. Mean control values were 1,039 ± 39.23 ms for native T1 mapping, 57 ± 5.18 ms for T2 mapping, and 31% ± 5.60% for ECV. Optimal thresholds were 1,021 ms for native T1 mapping, 52 ms for T2 mapping, and 28% for ECV based on receiver operating characteristic curves analysis based on 1.5-T scanner value. Native T1 mapping showed the highest diagnostic accuracy. Subgroup analysis found no significant sensitivity differences based on biopsy or clinical criteria.
Parametric mapping, particularly native T1, demonstrated strong diagnostic performance for acute myocarditis compared to T2 mapping and ECV within the modified 2018 Lake Louise Criteria framework. Incorporating these cardiovascular magnetic resonance parameters may improve diagnostic accuracy. Further research is recommended to refine these findings and optimize diagnostic strategies.
心血管磁共振成像参数——固有T1成像、T2成像和细胞外容积（ECV）——是根据2018年修订的路易斯湖标准（mLLC）诊断急性心肌炎的关键。本系统评价和荟萃分析评估了它们的诊断性能，并确定了急性心肌炎的最佳阈值。
我们回顾了过去十年中利用参数成像诊断心肌炎的文章。提取了敏感性、特异性和曲线下面积（AUC）的数据。由两名独立评审员使用QUADAS-2工具进行质量评估。
纳入了11项研究，共677例患者。固有T1成像的敏感性为83%，特异性为86%，诊断比值比（DOR）为39，AUC为0.91。T2成像的敏感性为81%，特异性为86%，DOR为25，AUC为0.89。ECV的敏感性为71%，特异性为81%，DOR为13，AUC为0.83。固有T1成像的平均对照值为1039±39.23毫秒，T2成像为57±5.18毫秒，ECV为31%±5.60%。根据基于1.5-T扫描仪值的受试者工作特征曲线分析，固有T1成像的最佳阈值为1021毫秒，T2成像为52毫秒，ECV为28%。固有T1成像显示出最高的诊断准确性。亚组分析发现，基于活检或临床标准，敏感性无显著差异。
在2018年修订的路易斯湖标准框架内，与T2成像和ECV相比，参数成像，尤其是固有T1成像，对急性心肌炎具有较强的诊断性能。纳入这些心血管磁共振参数可能会提高诊断准确性。建议进一步研究以完善这些发现并优化诊断策略。
