严重心肌炎患者的 CMR：包括细胞外容积成像在内的定量组织标志物的诊断价值。

CMR in patients with severe myocarditis: diagnostic value of quantitative tissue markers including extracellular volume imaging.

机构信息

University Heart Center, General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

JACC Cardiovasc Imaging. 2014 Jul;7(7):667-75. doi: 10.1016/j.jcmg.2014.02.005. Epub 2014 Jun 18.

DOI:10.1016/j.jcmg.2014.02.005

PMID:24954462

Abstract

OBJECTIVES

This study evaluated the accuracy of T2, T1, and extracellular volume (ECV) quantification as novel quantitative tissue markers in comparison with standard "Lake-Louise" cardiac magnetic resonance (CMR) criteria to diagnose myocarditis.

BACKGROUND

Novel approaches using T2 and T1 mapping may overcome the limitations of signal intensity-based parameters, which would potentially result in a better diagnostic accuracy compared with standard CMR techniques in suspected myocarditis.

METHODS

CMR was performed in 104 patients with myocarditis and 21 control subjects at 1.5-T. Patients with myocarditis underwent CMR 2 weeks (interquartile range: 1 to 7 weeks) after presentation with new-onset heart failure (n = 66) or acute chest pain (n = 38). T2 and T1 mapping were implemented into a standard protocol including T2-weighted (T2w), early gadolinium enhancement (EGE) CMR, and late gadolinium enhancement (LGE) CMR. T2 quantification was performed using a free-breathing, navigator-gated multiecho sequence. T1 quantification was performed using the modified Look-Locker inversion recovery sequence before and after administration of 0.075 mmol/kg gadobenate dimeglumine. T2, T1, and ECV maps were generated using a plug-in for the OsiriX software (Pixmeo, Bernex, Switzerland) to calculate mean global myocardial T2, T1, and ECV values.

RESULTS

The diagnostic accuracies of conventional CMR were 70% (95% confidence interval [CI]: 61% to 77%) for T2w CMR, 59% (95% CI: 56% to 73%) for EGE, and 67% (95% CI: 59% to 75%) for LGE. The diagnostic accuracies of mapping techniques were 63% (95% CI: 53% to 73%) for myocardial T2, 69% (95% CI: 60% to 76%) for native myocardial T1, and 76% (95% CI: 68% to 82%) for global myocardial ECV. The diagnostic accuracy of CMR was significantly improved to 90% (95% CI: 84% to 95%) by a stepwise approach, using the presence of LGE and myocardial ECV ≥27% as diagnostic criteria, compared with 79% (95% CI: 71% to 85%; p = 0.0043) for the Lake-Louise criteria.

CONCLUSIONS

In patients with clinical evidence for subacute, severe myocarditis, ECV quantification with LGE imaging significantly improved the diagnostic accuracy of CMR compared with standard Lake-Louise criteria.

摘要

目的

本研究旨在评估 T2、T1 和细胞外容积（ECV）定量作为新型定量组织标志物的准确性，与标准的“莱克-路易斯”心脏磁共振（CMR）标准相比，用于诊断心肌炎。

背景

使用 T2 和 T1 映射的新方法可能克服基于信号强度的参数的局限性，与标准 CMR 技术相比，在疑似心肌炎患者中，潜在的诊断准确性更高。

方法

在 1.5-T 上对 104 例心肌炎患者和 21 例对照进行 CMR 检查。心肌炎患者在新发心力衰竭（n=66）或急性胸痛（n=38）后 2 周（四分位距：1 至 7 周）进行 CMR。T2 和 T1 映射被纳入包括 T2 加权（T2w）、早期钆增强（EGE）CMR 和晚期钆增强（LGE）CMR 的标准方案。T2 定量是使用自由呼吸、导航门控多回波序列进行的。T1 定量是在使用 0.075mmol/kg 钆贝葡胺后使用改良 Look-Locker 反转恢复序列进行的。使用 OsiriX 软件（Pixmeo，Bernex，瑞士）的插件生成 T2、T1 和 ECV 图，以计算平均全局心肌 T2、T1 和 ECV 值。

结果

传统 CMR 的诊断准确性为 T2w CMR 为 70%（95%置信区间[CI]：61%至 77%），EGE 为 59%（95% CI：56%至 73%），LGE 为 67%（95% CI：59%至 75%）。映射技术的诊断准确性为心肌 T2 为 63%（95% CI：53%至 73%），原生心肌 T1 为 69%（95% CI：60%至 76%），全球心肌 ECV 为 76%（95% CI：68%至 82%）。与莱克-路易斯标准相比，使用 LGE 和心肌 ECV≥27%作为诊断标准的逐步方法将 CMR 的诊断准确性显著提高至 90%（95% CI：84%至 95%），而莱克-路易斯标准的诊断准确性为 79%（95% CI：71%至 85%；p=0.0043）。