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Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19.
Radiology. 2020 12; 297(3):E283-E288.R

Abstract

This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to coronavirus disease 2019 (COVID-19). Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis or conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was negative in nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 short tau inversion-recovery sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor postinfectious myocarditis in children and adolescents with COVID-19.

Authors+Show Affiliations

From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).From the Department of Imaging (E.B., C.S., H.D.l.P.), Pediatric Cardiovascular Unit (P.P.), Neonatal and Pediatric Intensive Care Unit (L.T., Y.L.), Virology Laboratory (A.S.), Department of Pediatrics (M.L.), and Pediatric Emergency Department (R.G.), Hôpital Trousseau-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Hôpital Armand-Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Biomedical Imaging Laboratory, Sorbonne Université, INSERM, CNRS, Paris, France (E.B., A.R.); Department of Cardiovascular and Thoracic Imaging and Interventional Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière-Assistance Publique-Hôpitaux Parisiens (AP-HP), Sorbonne Université, Paris, France (A.R.); and INSERM Laboratory U955-PHYDES-IMRB-Pharmacological and Therapeutic Strategies for Myocardial Ischemia and Heart Failure, Ecole Vétérinaire, Maisons-Alfort, France (Y.L.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32515676

Citation

Blondiaux, Eléonore, et al. "Cardiac MRI in Children With Multisystem Inflammatory Syndrome Associated With COVID-19." Radiology, vol. 297, no. 3, 2020, pp. E283-E288.
Blondiaux E, Parisot P, Redheuil A, et al. Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19. Radiology. 2020;297(3):E283-E288.
Blondiaux, E., Parisot, P., Redheuil, A., Tzaroukian, L., Levy, Y., Sileo, C., Schnuriger, A., Lorrot, M., Guedj, R., & Ducou le Pointe, H. (2020). Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19. Radiology, 297(3), E283-E288. https://doi.org/10.1148/radiol.2020202288
Blondiaux E, et al. Cardiac MRI in Children With Multisystem Inflammatory Syndrome Associated With COVID-19. Radiology. 2020;297(3):E283-E288. PubMed PMID: 32515676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac MRI in Children with Multisystem Inflammatory Syndrome Associated with COVID-19. AU - Blondiaux,Eléonore, AU - Parisot,Pauline, AU - Redheuil,Alban, AU - Tzaroukian,Lucile, AU - Levy,Yaël, AU - Sileo,Chiara, AU - Schnuriger,Aurélie, AU - Lorrot,Mathie, AU - Guedj,Romain, AU - Ducou le Pointe,Hubert, Y1 - 2020/06/09/ PY - 2020/6/10/pubmed PY - 2020/12/1/medline PY - 2020/6/10/entrez SP - E283 EP - E288 JF - Radiology JO - Radiology VL - 297 IS - 3 N2 - This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to coronavirus disease 2019 (COVID-19). Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis or conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was negative in nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 short tau inversion-recovery sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor postinfectious myocarditis in children and adolescents with COVID-19. SN - 1527-1315 UR - https://www.unboundmedicine.com/medline/citation/32515676/Cardiac_MRI_in_Children_with_Multisystem_Inflammatory_Syndrome_Associated_with_COVID_19_ L2 - https://pubs.rsna.org/doi/10.1148/radiol.2020202288?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -