Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
Department of Internal Medicine/Cardiology, Heart Center of the University Leipzig, Struempellstr. 39, 04289 Leipzig, Germany.
Eur Heart J Cardiovasc Imaging. 2014 Jun;15(6):643-50. doi: 10.1093/ehjci/jet267. Epub 2013 Dec 29.
The presence of pericardial effusion (PE) is considered to be suggestive of inflammation in suspected myocarditis. However, the incremental value of assessing for PE in addition to comprehensive cardiac magnetic resonance (CMR) imaging remains unclear.
In total, 132 patients with suspected acute (AMC) or chronic myocarditis (CMC) were included. All patients underwent endomyocardial biopsy (EMB) and CMR. Imaging protocols included T2 imaging for the assessment of myocardial oedema (oedema ratio [ER]), T1 imaging before and after contrast agent administration for global relative enhancement (gRE) calculation, and late enhancement (LE). Furthermore, the presence and extent of PE were determined. The potential incremental diagnostic value of PE was determined by applying a two, three, or four out of four criteria approach including ER, gRE, LE, and PE.
PE was present in 84 of the 132 patients (63.6%) and was more common in suspected AMC vs. CMC (56 of 70 vs. 28 of 62; P < 0.001). According to EMB results, PE was found in 86% of patients with AMC, 67% with chronic myocarditis, and 56% without evidence of myocardial inflammation. Implementing PE into a three out of four approach did not result in improved accuracy compared with the established two out of three approach using ER, gRE, and LE (59 vs. 68% for the total population, 69 vs. 79% for suspected AMC, and 48 vs. 52% for suspected CMC).
The finding of PE in unselected patients with suspected AMC or CMC is not specific to myocarditis. Therefore, with the currently applied criteria and methods, assessment of PE does not improve the diagnostic performance of CMR in this patient cohort.
心包积液（PE）的存在被认为提示疑似心肌炎存在炎症。然而，在全面心脏磁共振（CMR）成像之外评估心包积液的增量价值尚不清楚。
共纳入 132 例疑似急性（AMC）或慢性心肌炎（CMC）患者。所有患者均行心内膜心肌活检（EMB）和 CMR 检查。成像方案包括 T2 成像评估心肌水肿（水肿比[ER]）、对比剂给药前后 T1 成像计算整体相对增强（gRE）和延迟强化（LE），并确定心包积液的存在和程度。采用 ER、gRE、LE 和心包积液四项标准中二项、三项或四项标准方法确定心包积液的潜在增量诊断价值。
132 例患者中 84 例（63.6%）存在心包积液，疑似 AMC 患者较 CMC 患者更常见（70 例中有 56 例 vs. 62 例中有 28 例；P<0.001）。根据 EMB 结果，在 AMC 患者中，心包积液在 86%、慢性心肌炎患者中在 67%、无心肌炎症证据的患者中在 56%的患者中发现。在总人群中，与 ER、gRE 和 LE 的两项标准三分法相比，将心包积液纳入三项标准四分法并未提高准确性（59% vs. 68%），在疑似 AMC 患者中为 69% vs. 79%，在疑似 CMC 患者中为 48% vs. 52%。
在疑似 AMC 或 CMC 的未选择患者中发现心包积液对心肌炎不具有特异性。因此，在目前应用的标准和方法下，评估心包积液不会改善该患者队列中 CMR 的诊断性能。
