Applying quantitative CMR parameters for detecting myocardial lesion in immune checkpoint inhibitors-associated myocarditis

Shi-Hai Zhao; Hong Yun; Cai-Zhong Chen; Yin-Yin Chen; Jin-Yi Lin; Meng-Su Zeng; Tian-Shu Liu; Cui-Zhen Pan; Hang Jin

doi:10.1016/j.ejrad.2022.110558

Applying quantitative CMR parameters for detecting myocardial lesion in immune checkpoint inhibitors-associated myocarditis

Eur J Radiol. 2022 Nov:156:110558. doi: 10.1016/j.ejrad.2022.110558. Epub 2022 Oct 17.

Authors

Shi-Hai Zhao¹, Hong Yun¹, Cai-Zhong Chen¹, Yin-Yin Chen¹, Jin-Yi Lin², Meng-Su Zeng¹, Tian-Shu Liu³, Cui-Zhen Pan⁴, Hang Jin¹

Affiliations

¹ Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China; Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
³ Department of Medical Oncology, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: pcuizhen@126.com.

PMID: 36265221
DOI: 10.1016/j.ejrad.2022.110558

Abstract

Purpose: Sparse researches evaluated the quantitative cardiovascular magnetic resonance (CMR) parameters for immune checkpoint inhibitors (ICI)-associated myocarditis. We aimed to apply quantitative CMR mappings and late gadolinium enhancement (LGE) extent for detecting ICI-associated myocarditis.

Method: The retrospective study included patients with ICI-associated myocarditis and CMR examination from August 2018 to August 2021 in our hospital. ICI-associated myocarditis was clinically diagnosed based on the clinical criteria by European Society of Cardiology guidelines. The multiparametric CMR images including T2 mapping and black blood T2-weighted images were used to evaluate myocardial edema. The myocardial edema ratio (ER) ≥ 2.0 was applied for determining myocardial edema on T2-weighted images.

Results: 56 patients with ICI-associated myocarditis were included. The global T2 value and native T1 value of patients with ICI-associated myocarditis were significantly higher than the reference ranges in our hospital (p < 0.05). The rate of elevated global T2 value (92%) was significantly higher than those of abnormal native T1 value (73%), ER (52%) and LGE presence (68%) in patients with ICI-associated myocarditis (p < 0.05). The LGE extent and left ventricular ejection fraction of patients with ICI-associated myocarditis were 10.38 ± 9.64% and 56.42 ± 8.54%, respectively. LGE extent inversely correlated with left ventricular ejection fraction (r = -0.38, p = 0.004) but positively correlated with native T1 value (r = 0.28, p < 0.04) and extracellular volume (r = 0.50, p = 0.001).

Conclusions: T2 mapping could detect higher rate of patients with ICI-associated myocarditis than native T1 mapping, ER and LGE presence. LGE extent inversely correlated with left ventricular ejection fraction but positively correlated with native T1 value and extracellular volume in patients with ICI-associated myocarditis.

Keywords: Cardiovascular magnetic resonance; Immune checkpoint inhibitors; Late gadolinium enhancement; Myocarditis; T1 mapping; T2 mapping.