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Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis

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 diagno...

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Autores principales: Stirrat, Colin G, Alam, Shirjel R, MacGillivray, Thomas J, Gray, Calum D, Dweck, Marc R, Dibb, Kevin, Spath, Nick, Payne, John R, Prasad, Sanjay K, Gardner, Roy S, Mirsadraee, Saeed, Henriksen, Peter A, Semple, Scott IK, Newby, David E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861394/
https://www.ncbi.nlm.nih.gov/pubmed/28986407
http://dx.doi.org/10.1136/heartjnl-2017-311688
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author Stirrat, Colin G
Alam, Shirjel R
MacGillivray, Thomas J
Gray, Calum D
Dweck, Marc R
Dibb, Kevin
Spath, Nick
Payne, John R
Prasad, Sanjay K
Gardner, Roy S
Mirsadraee, Saeed
Henriksen, Peter A
Semple, Scott IK
Newby, David E
author_facet Stirrat, Colin G
Alam, Shirjel R
MacGillivray, Thomas J
Gray, Calum D
Dweck, Marc R
Dibb, Kevin
Spath, Nick
Payne, John R
Prasad, Sanjay K
Gardner, Roy S
Mirsadraee, Saeed
Henriksen, Peter A
Semple, Scott IK
Newby, David E
author_sort Stirrat, Colin G
collection PubMed
description 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.
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spelling pubmed-58613942018-03-22 Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis Stirrat, Colin G Alam, Shirjel R MacGillivray, Thomas J Gray, Calum D Dweck, Marc R Dibb, Kevin Spath, Nick Payne, John R Prasad, Sanjay K Gardner, Roy S Mirsadraee, Saeed Henriksen, Peter A Semple, Scott IK Newby, David E Heart Heart Failure and Cardiomyopathies 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. BMJ Publishing Group 2018-02 2017-10-06 /pmc/articles/PMC5861394/ /pubmed/28986407 http://dx.doi.org/10.1136/heartjnl-2017-311688 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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/
spellingShingle Heart Failure and Cardiomyopathies
Stirrat, Colin G
Alam, Shirjel R
MacGillivray, Thomas J
Gray, Calum D
Dweck, Marc R
Dibb, Kevin
Spath, Nick
Payne, John R
Prasad, Sanjay K
Gardner, Roy S
Mirsadraee, Saeed
Henriksen, Peter A
Semple, Scott IK
Newby, David E
Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title_full Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title_fullStr Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title_full_unstemmed Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title_short Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
title_sort ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
topic Heart Failure and Cardiomyopathies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5861394/
https://www.ncbi.nlm.nih.gov/pubmed/28986407
http://dx.doi.org/10.1136/heartjnl-2017-311688
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