Imaging for the diagnosis of acute myocarditis: can artificial intelligence improve diagnostic performance?

Front Cardiovasc Med. 2024 Aug 29:11:1408574. doi: 10.3389/fcvm.2024.1408574. eCollection 2024.

Abstract

Myocarditis is a cardiovascular disease characterised by inflammation of the heart muscle which can lead to heart failure. There is heterogeneity in the mode of presentation, underlying aetiologies, and clinical outcome with impact on a wide range of age groups which lead to diagnostic challenges. Cardiovascular magnetic resonance (CMR) is the preferred imaging modality in the diagnostic work-up of those with acute myocarditis. There is a need for systematic analytical approaches to improve diagnosis. Artificial intelligence (AI) and machine learning (ML) are increasingly used in CMR and has been shown to match human diagnostic performance in multiple disease categories. In this review article, we will describe the role of CMR in the diagnosis of acute myocarditis followed by a literature review on the applications of AI and ML to diagnose acute myocarditis. Only a few papers were identified with limitations in cases and control size and a lack of detail regarding cohort characteristics in addition to the absence of relevant cardiovascular disease controls. Furthermore, often CMR datasets did not include contemporary tissue characterisation parameters such as T1 and T2 mapping techniques, which are central to the diagnosis of acute myocarditis. Future work may include the use of explainability tools to enhance our confidence and understanding of the machine learning models with large, better characterised cohorts and clinical context improving the diagnosis of acute myocarditis.

Keywords: artificial intelligence; cardiac MRI; diagnosis; machine learning; myocarditis.

Publication types

  • Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. VS-S is supported by a Barts Charity Research Training Fellowship (G-002545). NA acknowledges support from Medical Research Council for his Clinician Scientist Fellowship (MR/X020924/1). SP and MA acknowledge support from the CAP-AI Programme, London's first AI enabling programme focused on stimulating growth in the capital's AI Sector. CAP-AI is led by Capital Enterprise in partnership with Barts Health NHS Trust and Digital Catapult and is funded by the European Regional Development Fund and Barts Charity. DH is supported by a British Heart Foundation Clinical Research Training Fellowship (FS/CRTF/20/24058). SP and GS wish to acknowledge the support of the National Institute for Health and Care Research Barts Biomedical Research Centre (NIHR203330); a delivery partnership of Barts Health NHS Trust, Queen Mary University of London, St George's University Hospitals NHS Foundation Trust and St George's University of London. AK is supported by the mini-Centre for Doctoral Training in AI-based Cardiac Image Computing provided through the Faculty of Science and Engineering, Queen Mary University of London.