De Cobelli Francesco, Pieroni Maurizio, Esposito Antonio, Chimenti Cristina, Belloni Elena, Mellone Renata, Canu Tamara, Perseghin Gianluca, Gaudio Carlo, Maseri Attilio, Frustaci Andrea, Del Maschio Alessandro
Radiology Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy.
J Am Coll Cardiol. 2006 Apr 18;47(8):1649-54. doi: 10.1016/j.jacc.2005.11.067. Epub 2006 Mar 29.
We evaluated the effectiveness of contrast-enhanced cardiac magnetic resonance (CE-CMR) in detecting chronic myocarditis (CM).
Chronic myocarditis represents a common evolution of acute myocarditis. Although CE-CMR has been revealed to be effective in identifying areas of myocardial damage in acute myocarditis, its role in the diagnosis of chronic myocardial inflammation has not yet been investigated.
Twenty-three patients with CM underwent CE-CMR and endomyocardial biopsy (EMB). Chronic myocarditis was defined by the presence of: 1) chronic (>6 months) heart failure symptoms and/or repetitive ventricular arrhythmias; 2) no history of recent flu-like symptoms or infections; and 3) histologic evidence of active myocarditis (AM) or borderline myocarditis (BM) according to Dallas criteria. Contrast-enhanced cardiac magnetic resonance included black-blood T2-weighted (BBT2w) images without and with fat saturation and delayed three-dimensional T1 turbo field-echo inversion-recovery sequences obtained 15 min after gadolinium injection.
Histology showed AM in 14 patients and BM in 9 patients. FatSat BBT2w revealed the presence of edema in five (36%) patients with AM but not in BM patients. Areas of late enhancement (LE) were observed in 12 (84%) subjects with AM and in 4 (44%) cases with BM. A mid-wall LE pattern was the most frequent finding in both groups while a subepicardial distribution of LE was observed only in patients with AM.
Contrast-enhanced cardiac magnetic resonance identified areas of myocardial inflammation in up to 70% of patients with biopsy-proven CM. We suggest that CE-CMR may be a useful non-invasive diagnostic tool in patients with CM, and it may indicate and even guide the execution of left ventricular EMB with relevant prognostic and therapeutic implications.
我们评估了对比增强心脏磁共振成像（CE-CMR）在检测慢性心肌炎（CM）方面的有效性。
慢性心肌炎是急性心肌炎常见的演变结果。尽管已证实CE-CMR在识别急性心肌炎的心肌损伤区域方面有效，但其在慢性心肌炎症诊断中的作用尚未得到研究。
23例CM患者接受了CE-CMR和心内膜心肌活检（EMB）。慢性心肌炎的定义为：1）存在慢性（>6个月）心力衰竭症状和/或反复室性心律失常；2）近期无流感样症状或感染史；3）根据达拉斯标准有活动性心肌炎（AM）或临界性心肌炎（BM）的组织学证据。对比增强心脏磁共振成像包括无脂肪饱和和有脂肪饱和的黑血T2加权（BBT2w）图像，以及在注射钆剂15分钟后获得的延迟三维T1涡轮场回波反转恢复序列。
组织学显示14例患者为AM，9例患者为BM。脂肪饱和BBT2w显示5例（36%）AM患者存在水肿，而BM患者未出现。12例（84%）AM患者和4例（44%）BM患者观察到延迟强化（LE）区域。两组中最常见的表现均为中层壁LE模式，而仅在AM患者中观察到LE的心外膜下分布。
对比增强心脏磁共振成像在高达70%经活检证实的CM患者中识别出心肌炎症区域。我们认为CE-CMR可能是CM患者有用的非侵入性诊断工具，它可能提示甚至指导左心室EMB的实施，具有相关的预后和治疗意义。
