Abdel-Aty Hassan, Boyé Philipp, Zagrosek Anja, Wassmuth Ralf, Kumar Andreas, Messroghli Daniel, Bock Petra, Dietz Rainer, Friedrich Matthias G, Schulz-Menger Jeanette
Franz-Volhard-Klinik, Charité Campus Buch, Universität Medizin Berlin, Berlin, Germany.
J Am Coll Cardiol. 2005 Jun 7;45(11):1815-22. doi: 10.1016/j.jacc.2004.11.069.
The aim of this research was to identify the diagnostic performance of gadolinium-enhanced and T2-weighted cardiovascular magnetic resonance (CMR) in suspected acute myocarditis.
Acute myocarditis is difficult to diagnose; CMR provides various means to visualize myocardial inflammatory changes. A CMR approach with clear-cut diagnostic criteria would be desirable.
We investigated 25 patients with suspected acute myocarditis (18 males, 44 +/- 17 years) and 23 healthy controls (13 males, 29 +/- 10 years). Cardiovascular magnetic resonance studies included the following sequences: 1) T2-weighted triple inversion recovery; 2) T1-weighted spin echo before and over 4 min after gadolinium injection; and 3) inversion recovery-gradient echo 10 min after gadolinium injection. Qualitative and quantitative image analysis was performed for: 1) focal and global T2 signal intensity (SI); 2) myocardial global relative enhancement (gRE); and 3) areas of late gadolinium enhancement (LGE).
Both global T2 SI and gRE were higher in patients than in controls (T2: 2.3 +/- 0.4 vs. 1.7 +/- 0.4; p < 0.0001, gRE: 6.8 +/- 4.0 vs. 3.7 +/- 2.3; p < 0.001). The sensitivity, specificity, and diagnostic accuracy for T2 (cutoff value of 1.9) were 84%, 74%, and 79%, respectively; gRE: (cutoff value of 4.0) 80%, 68%, and 74.5% respectively; LGE: 44%, 100%, and 71%, respectively. The best diagnostic performance was obtained when "any-two" of the three sequences were positive in the same patient yielding a 76% sensitivity, 95.5% specificity, and 85% diagnostic accuracy.
A combined CMR approach using T2-weighted imaging, early and late gadolinium enhancement, provides a high diagnostic accuracy and is a useful tool in the diagnosis and assessment of patients with suspected acute myocarditis.
本研究旨在确定钆增强和T2加权心血管磁共振成像（CMR）在疑似急性心肌炎中的诊断性能。
急性心肌炎难以诊断；CMR提供了多种可视化心肌炎症变化的方法。一种具有明确诊断标准的CMR方法将是可取的。
我们调查了25例疑似急性心肌炎患者（18例男性，44±17岁）和23名健康对照者（13例男性，29±10岁）。心血管磁共振研究包括以下序列：1）T2加权三重反转恢复序列；2）钆注射前及注射后4分钟以上的T1加权自旋回波序列；3）钆注射后10分钟的反转恢复梯度回波序列。对以下方面进行定性和定量图像分析：1）局灶性和整体T2信号强度（SI）；2）心肌整体相对增强（gRE）；3）钆延迟增强（LGE）区域。
患者的整体T2 SI和gRE均高于对照组（T2：2.3±0.4对1.7±0.4；p<0.0001，gRE：6.8±4.0对3.7±2.3；p<0.001）。T2（临界值为1.9）的敏感性、特异性和诊断准确性分别为84%、74%和79%；gRE（临界值为4.0）分别为80%、68%和74.5%；LGE分别为44%、100%和71%。当三个序列中的“任意两个”在同一患者中呈阳性时，诊断性能最佳，敏感性为76%，特异性为95.5%，诊断准确性为85%。
使用T2加权成像、钆早期和延迟增强的联合CMR方法具有较高的诊断准确性，是诊断和评估疑似急性心肌炎患者的有用工具。
