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      SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance

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          Abstract

          The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.

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          Most cited references366

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          An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study

          Summary Background The Bergamo province, which is extensively affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, is a natural observatory of virus manifestations in the general population. In the past month we recorded an outbreak of Kawasaki disease; we aimed to evaluate incidence and features of patients with Kawasaki-like disease diagnosed during the SARS-CoV-2 epidemic. Methods All patients diagnosed with a Kawasaki-like disease at our centre in the past 5 years were divided according to symptomatic presentation before (group 1) or after (group 2) the beginning of the SARS-CoV-2 epidemic. Kawasaki- like presentations were managed as Kawasaki disease according to the American Heart Association indications. Kawasaki disease shock syndrome (KDSS) was defined by presence of circulatory dysfunction, and macrophage activation syndrome (MAS) by the Paediatric Rheumatology International Trials Organisation criteria. Current or previous infection was sought by reverse-transcriptase quantitative PCR in nasopharyngeal and oropharyngeal swabs, and by serological qualitative test detecting SARS-CoV-2 IgM and IgG, respectively. Findings Group 1 comprised 19 patients (seven boys, 12 girls; aged 3·0 years [SD 2·5]) diagnosed between Jan 1, 2015, and Feb 17, 2020. Group 2 included ten patients (seven boys, three girls; aged 7·5 years [SD 3·5]) diagnosed between Feb 18 and April 20, 2020; eight of ten were positive for IgG or IgM, or both. The two groups differed in disease incidence (group 1 vs group 2, 0·3 vs ten per month), mean age (3·0 vs 7·5 years), cardiac involvement (two of 19 vs six of ten), KDSS (zero of 19 vs five of ten), MAS (zero of 19 vs five of ten), and need for adjunctive steroid treatment (three of 19 vs eight of ten; all p<0·01). Interpretation In the past month we found a 30-fold increased incidence of Kawasaki-like disease. Children diagnosed after the SARS-CoV-2 epidemic began showed evidence of immune response to the virus, were older, had a higher rate of cardiac involvement, and features of MAS. The SARS-CoV-2 epidemic was associated with high incidence of a severe form of Kawasaki disease. A similar outbreak of Kawasaki-like disease is expected in countries involved in the SARS-CoV-2 epidemic. Funding None.
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            Fourth Universal Definition of Myocardial Infarction (2018)

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              Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation

              This JACC Scientific Expert Panel provides consensus recommendations for an update of the cardiovascular magnetic resonance (CMR) diagnostic criteria for myocardial inflammation in patients with suspected acute or active myocardial inflammation (Lake Louise Criteria) that include options to use parametric mapping techniques. While each parameter may indicate myocardial inflammation, the authors propose that CMR provides strong evidence for myocardial inflammation, with increasing specificity, if the CMR scan demonstrates the combination of myocardial edema with other CMR markers of inflammatory myocardial injury. This is based on at least one T2-based criterion (global or regional increase of myocardial T2 relaxation time or an increased signal intensity in T2-weighted CMR images), with at least one T1-based criterion (increased myocardial T1, extracellular volume, or late gadolinium enhancement). While having both a positive T2-based marker and a T1-based marker will increase specificity for diagnosing acute myocardial inflammation, having only one (i.e., T2-based OR T1-based) marker may still support a diagnosis of acute myocardial inflammation in an appropriate clinical scenario, albeit with less specificity. The update is expected to improve the diagnostic accuracy of CMR further in detecting myocardial inflammation.
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                Author and article information

                Contributors
                t.leiner@umcutrecht.nl
                Journal
                J Cardiovasc Magn Reson
                J Cardiovasc Magn Reson
                Journal of Cardiovascular Magnetic Resonance
                BioMed Central (London )
                1097-6647
                1532-429X
                9 November 2020
                9 November 2020
                2020
                : 22
                : 76
                Affiliations
                [1 ]GRID grid.7692.a, ISNI 0000000090126352, Department of Radiology, E.01.132, , Utrecht University Medical Center, ; Heidelberglaan 100, 3584CX Utrecht, The Netherlands
                [2 ]GRID grid.410569.f, ISNI 0000 0004 0626 3338, Department of Radiology, , University Hospitals Leuven, ; Leuven, Belgium
                [3 ]GRID grid.5596.f, ISNI 0000 0001 0668 7884, Department of Imaging and Pathology, , Catholic University Leuven, ; Herestraat 49, 3000 Leuven, Belgium
                [4 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Departments of Medicine and Diagnostic Radiology, , McGill University, ; 1001 Decarie Blvd., Montreal, QC H4A 3J1 Canada
                [5 ]GRID grid.439338.6, ISNI 0000 0001 1114 4366, Department of Radiology, , Royal Brompton Hospital, ; Sydney Street, Chelsea, London, SW3 6NP UK
                [6 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, National Heart and Lung Institute, Imperial College, ; South Kensington Campus, London, SW7 2AZ UK
                [7 ]GRID grid.83440.3b, ISNI 0000000121901201, Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, , UCL Institute of Cardiovascular, ; Great Ormond Street, London, WC1N 3JH UK
                [8 ]Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU UK
                [9 ]GRID grid.2515.3, ISNI 0000 0004 0378 8438, Department of Cardiology, , Boston Children’s Hospital, ; 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA 02115 USA
                [10 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Pediatrics, , Harvard Medical School, ; 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA 02115 USA
                [11 ]GRID grid.257413.6, ISNI 0000 0001 2287 3919, Krannert Institute of Cardiology, Indiana University School of Medicine, ; 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082 USA
                [12 ]GRID grid.439338.6, ISNI 0000 0001 1114 4366, Royal Brompton Hospital, ; Sydney Street, Chelsea, London, SW3 6NP UK
                [13 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Imperial College, ; South Kensington Campus, London, SW7 2AZ UK
                Article
                682
                10.1186/s12968-020-00682-4
                7649060
                33161900
                5dc0116e-5890-4081-8033-3cd959bca130
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 September 2020
                : 18 September 2020
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                © The Author(s) 2020

                Cardiovascular Medicine
                Cardiovascular Medicine

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