Etesami Maryam, Gilkeson Robert C, Rajiah Prabhakar
Cardiothoracic Imaging, Department of Radiology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
Pediatr Radiol. 2016 Jul;46(8):1096-113. doi: 10.1007/s00247-015-3526-2. Epub 2015 Dec 30.
Late gadolinium enhancement (LGE) cardiac magnetic resonance (MR) imaging sequence is increasingly used in the evaluation of pediatric cardiovascular disorders, and although LGE might be a normal feature at the sites of previous surgeries, it is pathologically seen as a result of extracellular space expansion, either from acute cell damage or chronic scarring or fibrosis. LGE is broadly divided into ischemic and non-ischemic patterns. LGE caused by myocardial infarction occurs in a vascular distribution and always involves the subendocardial portion, progressively involving the outer regions in a waveform pattern. Non-ischemic cardiomyopathies can have a mid-myocardial (either linear or patchy), subepicardial or diffuse subendocardial distribution. Idiopathic dilated cardiomyopathy can have a linear mid-myocardial pattern, while hypertrophic cardiomyopathy can have fine, patchy enhancement in hypertrophied and non-hypertrophied segments as well as right ventricular insertion points. Myocarditis and sarcoidosis have a mid-myocardial or subepicardial pattern of LGE. Fabry disease typically affects the basal inferolateral segment while Danon disease typically spares the septum. Pericarditis is characterized by diffuse or focal pericardial thickening and enhancement. Thrombus, the most common non-neoplastic cardiac mass, is characterized by absence of enhancement in all sequences, while neoplastic masses show at least some contrast enhancement, depending on the pathology. Regardless of the etiology, presence of LGE is associated with a poor prognosis. In this review, we describe the technical modifications required for performing LGE cardiac MR sequence in children, review and illustrate the patterns of LGE in children, and discuss their clinical significance.
延迟钆增强（LGE）心脏磁共振（MR）成像序列在儿科心血管疾病评估中的应用日益广泛。虽然LGE在既往手术部位可能是正常表现，但在病理上它是细胞外间隙扩张的结果，这可能源于急性细胞损伤、慢性瘢痕形成或纤维化。LGE大致分为缺血性和非缺血性模式。心肌梗死所致的LGE呈血管分布，总是累及心内膜下部分，并逐渐呈波形模式累及外层区域。非缺血性心肌病的LGE可呈心肌中层（线性或斑片状）、心外膜下或弥漫性心内膜下分布。特发性扩张型心肌病可呈线性心肌中层模式，而肥厚型心肌病在肥厚和非肥厚节段以及右心室插入点可出现细微的斑片状强化。心肌炎和结节病的LGE呈心肌中层或心外膜下模式。法布里病通常累及基底后外侧节段，而丹农病通常不累及室间隔。心包炎的特征是心包弥漫性或局灶性增厚及强化。血栓是最常见的非肿瘤性心脏肿块，其特征是在所有序列中均无强化，而肿瘤性肿块根据病理情况至少会有一些对比剂强化。无论病因如何，LGE的存在都与预后不良相关。在本综述中，我们描述了在儿童中进行LGE心脏MR序列所需的技术改进，回顾并阐述了儿童LGE的模式，并讨论了它们的临床意义。
