Magnetic resonance imaging in the diagnosis of myocarditis in children

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Abstract

Background: There is a need for the systematization, generalization and analysis of the structural changes of the myocardium, occurring in patients with myocarditis. This disease is rare; therefore, structured information in the field of radiological diagnostics is still insufficient within national publications.

Aim: The study purpose was to determine the significance and specificity of changes observed in cardiac magnetic resonance images in patients with myocarditis, and to compare the obtained results with the literature data.

Methods: 7 patients, including children aged 4 and 6, with a verified diagnosis of myocarditis were retrospectively examined.

Results: The analysis of the obtained images revealed the most common changes related to myocarditis, such as myocardial edema, impaired myocardial contractility, increased delayed accumulation of the contrast agent. The pathophysiological mechanisms of the found structural changes were analyzed and described.

Conclusion: Magnetic resonance imaging is the most important non-invasive method for diagnosing myocarditis, which allows one to identify the lesion of the heart muscle, to assess the extent of its damage, to differentiate myocarditis from other diseases, as well as to assess the dynamics when evaluating the effectiveness of therapy.

About the authors

Lyubov E. Fomina

National Medical Research Center for Children’s Health

Author for correspondence.
Email: love.fomina@mail.ru
ORCID iD: 0000-0002-3838-3284
SPIN-code: 1298-8350
Russian Federation, Moscow

Igor I. Yarmola

National Medical Research Center for Children’s Health

Email: lord_Dukich@bk.ru
ORCID iD: 0000-0002-1272-5119
SPIN-code: 5591-8066
Russian Federation, Moscow

Vladimir I. Barskiy

National Medical Research Center for Children’s Health

Email: woowka@mail.ru
ORCID iD: 0000-0003-1267-1517
Russian Federation, Moscow

Anatoly V. Anikin

National Medical Research Center for Children’s Health

Email: anikacor@gmail.com
SPIN-code: 7592-1352

MD, PhD

Russian Federation, Moscow

Elena V. Uglova

National Medical Research Center for Children’s Health

Email: uglova8@gmail.com
Russian Federation, Moscow

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2. Fig. 1. Cardiac magnetic resonance imaging, STIR sequence, short axis plane: а — the arrow indicates the local area of myocardial edema of the interventricular septum; б — the arrow indicates а the diffuse zone of myocardial edema of the anterior and lateral walls of the left ventricle.

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3. Fig. 2. Cardiac magnetic resonance imaging, Cine Fiesta sequence, short axis plane: а — diastole, the short arrow indicates the inferior wall of the left ventricle with a normal thickness, the long arrow points to the area of myocardial thinning; б — systole, the short arrows indicate thickening during the contraction of the normal myocardium of the left ventricle, the long arrow points to the site of akinesis in the damaged myocardium.

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4. Fig. 3. Cardiac magnetic resonance imaging, myocardium delayed enhancement series (MDE): а — short axis plane; б — 4-chamber plane. The arrows indicate intramyocardial foci of the contrast enhancement, corresponding to inflammation.

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5. Fig. 4. A schematic picture along the short axis of the heart. Various patterns of delayed contrast enhancement are presented: а — subepicardial; б — subendocardial; в — intramyocardial (intramural); г — transmural.

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6. Fig. 5. Cardiac magnetic resonance imaging, delayed contrast enhancement series (MDE), short axis plane. The arrows indicate the areas of the contrast enhancement in the subepicardial foci of the myocardium and the adjacent part of the pericardium.

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