Skip to main content
NCBI home page
Netherlands Heart Journal logoLink to Netherlands Heart Journal
. 2003 Apr;11(4):163–168.

Novel ways to noninvasively detect inflammation of the myocardium: contrast-enhanced MRI and myocardial contrast echocardiography

MR van den Brink, CA Geluk, JR Lindner, BK Velthuis, EJ Vonken, MJM Cramer
PMCID: PMC2499839  PMID: 25696203

Abstract

Both contrast-enhanced magnetic resonance imaging (CE-MRI) and myocardial contrast echocardiography (MCE) are promising tools to detect cardiac inflammation. CE-MRI can be used to characterise the location and extent of myocardial inflammation, since areas of abnormal signal enhancement associated with regional wall motion abnormalities reliably indicate areas of active myocarditis. In MCE, chemically composed microbubbles can be visualised by ultrasound and used to determine the status of the cardiac microvasculature. If there is any inflammation the microbubbles will be phagocytosed by neutrophils and monocytes, thus enabling the degree of inflammation to be assessed.

These noninvasive techniques may allow early diagnosis and accurate evaluation of myocardial inflammation.

Keywords: inflammation, myocardial contrast echocardiography, contrast-enhanced MRI, myocarditis

Full text

PDF
163

Images in this article

165Figure 1
on p.165
165Figure 2
on p.165
166Figure 3
on p.166
167Figure 4
on p.167

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Angelini A., Calzolari V., Calabrese F., Boffa G. M., Maddalena F., Chioin R., Thiene G. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart. 2000 Sep;84(3):245–250. doi: 10.1136/heart.84.3.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beache G. M., Wedeen V. J., Weisskoff R. M., O'Gara P. T., Poncelet B. P., Chesler D. A., Brady T. J., Rosen B. R., Dinsmore R. E. Intramural mechanics in hypertrophic cardiomyopathy: functional mapping with strain-rate MR imaging. Radiology. 1995 Oct;197(1):117–124. doi: 10.1148/radiology.197.1.7568808. [DOI] [PubMed] [Google Scholar]
  3. Bhattacharya S., Lahiri A. Clinical role of indium-111 antimyosin imaging. Eur J Nucl Med. 1991;18(11):889–895. doi: 10.1007/BF02258455. [DOI] [PubMed] [Google Scholar]
  4. Di Cesare E. MRI of the cardiomyopathies. Eur J Radiol. 2001 Jun;38(3):179–184. doi: 10.1016/s0720-048x(01)00311-4. [DOI] [PubMed] [Google Scholar]
  5. Feldman A. M., McNamara D. Myocarditis. N Engl J Med. 2000 Nov 9;343(19):1388–1398. doi: 10.1056/NEJM200011093431908. [DOI] [PubMed] [Google Scholar]
  6. Firschke C., Lindner J. R., Wei K., Goodman N. C., Skyba D. M., Kaul S. Myocardial perfusion imaging in the setting of coronary artery stenosis and acute myocardial infarction using venous injection of a second-generation echocardiographic contrast agent. Circulation. 1997 Aug 5;96(3):959–967. [PubMed] [Google Scholar]
  7. Frank H., Globits S. Magnetic resonance imaging evaluation of myocardial and pericardial disease. J Magn Reson Imaging. 1999 Nov;10(5):617–626. doi: 10.1002/(sici)1522-2586(199911)10:5<617::aid-jmri5>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  8. Friedrich M. G., Strohm O., Schulz-Menger J., Marciniak H., Luft F. C., Dietz R. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation. 1998 May 12;97(18):1802–1809. doi: 10.1161/01.cir.97.18.1802. [DOI] [PubMed] [Google Scholar]
  9. Gagliardi M. G., Bevilacqua M., Di Renzi P., Picardo S., Passariello R., Marcelletti C. Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am J Cardiol. 1991 Oct 15;68(10):1089–1091. doi: 10.1016/0002-9149(91)90501-b. [DOI] [PubMed] [Google Scholar]
  10. Kassab G. S., Lin D. H., Fung Y. C. Morphometry of pig coronary venous system. Am J Physiol. 1994 Dec;267(6 Pt 2):H2100–H2113. doi: 10.1152/ajpheart.1994.267.6.H2100. [DOI] [PubMed] [Google Scholar]
  11. Kaul S. Myocardial contrast echocardiography: 15 years of research and development. Circulation. 1997 Nov 18;96(10):3745–3760. doi: 10.1161/01.cir.96.10.3745. [DOI] [PubMed] [Google Scholar]
  12. Keller M. W., Segal S. S., Kaul S., Duling B. The behavior of sonicated albumin microbubbles within the microcirculation: a basis for their use during myocardial contrast echocardiography. Circ Res. 1989 Aug;65(2):458–467. doi: 10.1161/01.res.65.2.458. [DOI] [PubMed] [Google Scholar]
  13. Libby Peter, Ridker Paul M., Maseri Attilio. Inflammation and atherosclerosis. Circulation. 2002 Mar 5;105(9):1135–1143. doi: 10.1161/hc0902.104353. [DOI] [PubMed] [Google Scholar]
  14. Lindner J. R. Assessment of inflammation with contrast ultrasound. Prog Cardiovasc Dis. 2001 Sep-Oct;44(2):111–120. doi: 10.1053/pcad.2001.26439. [DOI] [PubMed] [Google Scholar]
  15. Lindner J. R., Coggins M. P., Kaul S., Klibanov A. L., Brandenburger G. H., Ley K. Microbubble persistence in the microcirculation during ischemia/reperfusion and inflammation is caused by integrin- and complement-mediated adherence to activated leukocytes. Circulation. 2000 Feb 15;101(6):668–675. doi: 10.1161/01.cir.101.6.668. [DOI] [PubMed] [Google Scholar]
  16. Lindner J. R., Dayton P. A., Coggins M. P., Ley K., Song J., Ferrara K., Kaul S. Noninvasive imaging of inflammation by ultrasound detection of phagocytosed microbubbles. Circulation. 2000 Aug 1;102(5):531–538. doi: 10.1161/01.cir.102.5.531. [DOI] [PubMed] [Google Scholar]
  17. Lindner J. R., Song J., Xu F., Klibanov A. L., Singbartl K., Ley K., Kaul S. Noninvasive ultrasound imaging of inflammation using microbubbles targeted to activated leukocytes. Circulation. 2000 Nov 28;102(22):2745–2750. doi: 10.1161/01.cir.102.22.2745. [DOI] [PubMed] [Google Scholar]
  18. Lindner Jonathan R., Wei Kevin, Kaul Sanjiv. Imaging of Myocardial Perfusion with SonoVuetrade mark in Patients with a Prior Myocardial Infarction. Echocardiography. 1999 Oct;16(7 Pt 2):753–760. doi: 10.1111/j.1540-8175.1999.tb00146.x. [DOI] [PubMed] [Google Scholar]
  19. Linka A. Z., Skyba D. M., Price R. J., Wei K., Skalak T. C., Kaul S. Spontaneous redistribution after reperfusion: a unique property of AIP 201, an ultrasound contrast agent. J Am Coll Cardiol. 1998 Nov 15;32(6):1765–1772. doi: 10.1016/s0735-1097(98)00453-7. [DOI] [PubMed] [Google Scholar]
  20. McCarthy R. E., 3rd, Boehmer J. P., Hruban R. H., Hutchins G. M., Kasper E. K., Hare J. M., Baughman K. L. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000 Mar 9;342(10):690–695. doi: 10.1056/NEJM200003093421003. [DOI] [PubMed] [Google Scholar]
  21. Morguet A. J., Munz D. L., Kreuzer H., Emrich D. Scintigraphic detection of inflammatory heart disease. Eur J Nucl Med. 1994 Jul;21(7):666–674. doi: 10.1007/BF00285591. [DOI] [PubMed] [Google Scholar]
  22. Pennell D. Cardiovascular magnetic resonance. Heart. 2001 May;85(5):581–589. doi: 10.1136/heart.85.5.581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Roditi G. H., Hartnell G. G., Cohen M. C. MRI changes in myocarditis--evaluation with spin echo, cine MR angiography and contrast enhanced spin echo imaging. Clin Radiol. 2000 Oct;55(10):752–758. doi: 10.1053/crad.2000.0519. [DOI] [PubMed] [Google Scholar]
  24. Skyba D. M., Jayaweera A. R., Goodman N. C., Ismail S., Camarano G., Kaul S. Quantification of myocardial perfusion with myocardial contrast echocardiography during left atrial injection of contrast. Implications for venous injection. Circulation. 1994 Sep;90(3):1513–1521. doi: 10.1161/01.cir.90.3.1513. [DOI] [PubMed] [Google Scholar]
  25. Skyba D. M., Price R. J., Linka A. Z., Skalak T. C., Kaul S. Direct in vivo visualization of intravascular destruction of microbubbles by ultrasound and its local effects on tissue. Circulation. 1998 Jul 28;98(4):290–293. doi: 10.1161/01.cir.98.4.290. [DOI] [PubMed] [Google Scholar]
  26. Wei K., Jayaweera A. R., Firoozan S., Linka A., Skyba D. M., Kaul S. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation. 1998 Feb 10;97(5):473–483. doi: 10.1161/01.cir.97.5.473. [DOI] [PubMed] [Google Scholar]

Articles from Netherlands Heart Journal are provided here courtesy of Springer

RESOURCES