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Heart failure and cardiomyopathies
Original research article
Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
  1. Colin G Stirrat1,
  2. Shirjel R Alam1,
  3. Thomas J MacGillivray2,3,
  4. Calum D Gray2,3,
  5. Marc R Dweck1,
  6. Kevin Dibb1,
  7. Nick Spath1,
  8. John R Payne4,
  9. Sanjay K Prasad5,
  10. Roy S Gardner4,
  11. Saeed Mirsadraee6,
  12. Peter A Henriksen1,
  13. Scott IK Semple1,3,
  14. David E Newby1,3
  1. 1 British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2 Clinical Research Facility, University of Edinburgh, Edinburgh, UK
  3. 3 Edinburgh Imaging QMRI Facility, University of Edinburgh, Edinburgh, UK
  4. 4 Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
  5. 5 Department of Cardiology, Royal Brompton Hospital, London, UK
  6. 6 Department of Radiology, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr Colin G Stirrat, British Heart Foundation, University Centre for Cardiovascular Science, Room SU 305 Chancellor’s Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK; colin.stirrat{at}ed.ac.uk

Abstract

Objectives Ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect tissue-resident macrophage activity and identify cellular inflammation within tissues. We hypothesised that USPIO-enhanced MRI would provide a non-invasive imaging technique that would improve the diagnosis and management of patients with acute myocarditis.

Methods Ten volunteers and 14 patients with suspected acute myocarditis underwent T2, T2* and late gadolinium enhancement (LGE) 3T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months. Myocardial oedema and USPIO enhancement were determined within areas of LGE as well as throughout the myocardium.

Results Myocarditis was confirmed in nine of the 14 suspected cases of myocarditis. There was greater myocardial oedema in regions of LGE in patients with myocarditis when compared with healthy volunteer myocardium (T2 value, 57.1±5.3 vs 46.7±1.6 ms, p<0.0001). There was no demonstrable difference in USPIO enhancement between patients and volunteers even within regions displaying LGE (change in R2*, 35.0±15.0 vs 37.2±9.6 s−1, p>0.05). Imaging after 3 months in patients with myocarditis revealed a reduction in volume of LGE, a reduction in oedema measures within regions displaying LGE and improvement in ejection fraction (mean −19.7 mL, 95% CI (−0.5 to −40.0)), −5.8 ms (−0.9 to −10.7) and +6% (0.5% to 11.5%), respectively, p<0.05 for all).

Conclusion In patients with acute myocarditis, USPIO-enhanced MRI does not provide additional clinically relevant information to LGE and T2 mapping MRI. This suggests that tissue-resident macrophages do not provide a substantial contribution to the myocardial inflammation in this condition.

Clinical trial registration NCT02319278; Results.

  • cardiac
  • MRI
  • myocarditis
  • inflammation
  • USPIO.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2017-311688

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    Footnotes

    • Contributors CGS, SRA, SIKS and DEN designed the study, collected and analysed the data and drafted the manuscript. TJM, CDG, KD and NS analysed and interpreted the data and drafted the manuscript. MRD, JRP, SKP, RSG, SM and PAH designed the study and drafted the manuscript. All authors read and approved the manuscript. CGS is responsible for overall content as guarantor.

    • Funding This work was supported by the Chief Scientist Office (ETM/266).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Scotland A Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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