心肌炎患者的早期心肌钆增强：使用单剂量 0.1mmol/Kg 高弛豫率钆基对比剂验证“路易斯湖共识”标准。
Early myocardial gadolinium enhancement in patients with myocarditis: Validation of "Lake Louise consensus" criteria using a single bolus of 0.1mmol/Kg of a high relaxivity gadolinium-based contrast agent.
机构信息
Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
出版信息
Eur J Radiol. 2017 Oct;95:89-95. doi: 10.1016/j.ejrad.2017.07.008. Epub 2017 Jul 27.
OBJECTIVES
Global early gadolinium enhancement (EGE) is an accepted cardiac magnetic resonance (CMR) criterion for diagnosis of myocarditis. However, recommended enhancement thresholds are based specifically on standard-relaxivity Gd-chelates. We evaluated the performance of a high relaxivity MR contrast agent for detection of myocardial hyperemia in patients referred for endomyocardial biopsy (EMB).
METHODS
We retrospectively enrolled 54 patients (mean age: 44.1 years [range=18-77years]; 72% men) with suspected myocarditis who underwent CMR and EMB within four weeks of clinical onset. CMR imaging protocol included T2-weighted short tau inversion-recovery sequence, EGE and late gadolinium enhanced (LGE) imaging. For EGE imaging, free-breathing ECG-gated turbo spin echo T1-weighted (TSE T1w) sequences were acquired before and within the first three minutes after gadobenate dimeglumine (0.1mmol/Kg) administration. The ratio (EGEr) between myocardial and musculoskeletal early enhancement was calculated. Myocardial edema, EGE and late gadolinium enhancement (LGE) were correlated with EMB results. Receiver operating characteristic (ROC) curve analysis of EGE values was applied on the overall population.
RESULTS
EMB revealed myocarditis in 34/54 patients. Sensitivity, specificity and accuracy values of 0.61, 0.85 and 0.70, respectively, were obtained for a standard EGE threshold (EGEr>4.0). ROC analysis revealed an area under the curve of 0.701 for EGEr (IC95%:0.556-0.846, p=0.014) and 0.706 for absolute enhancement (IC95%:0.563-0.849, p=0.012). Sensitivity, specificity and accuracy values were 0.67, 0.80 and 0.72, respectively, for myocardial edema and 0.76, 0.75 and 0.76, respectively, for LGE.
CONCLUSIONS
High relaxivity contrast agents provide comparable results to standard-relaxivity chelates for EGE assessment in diagnosing myocarditis.
目的
全球早期钆增强（EGE）是诊断心肌炎的一种被接受的心脏磁共振（CMR）标准。然而，推荐的增强阈值是专门基于标准弛豫性 Gd 螯合物的。我们评估了一种高弛豫性磁共振对比剂在检测因疑似心肌炎而行心内膜心肌活检（EMB）的患者心肌充血的性能。
方法
我们回顾性纳入了 54 例（平均年龄：44.1 岁[范围 18-77 岁]；72%为男性）在临床发病后 4 周内行 CMR 和 EMB 的疑似心肌炎患者。CMR 成像方案包括 T2 加权短 tau 反转恢复序列、EGE 和晚期钆增强（LGE）成像。对于 EGE 成像，在注射钆贝葡胺（0.1mmol/Kg）前和注射后前 3 分钟内采集自由呼吸心电图门控 turbo 自旋回波 T1 加权（TSE T1w）序列。计算心肌和肌肉骨骼早期增强之间的比值（EGEr）。心肌水肿、EGE 和晚期钆增强（LGE）与 EMB 结果相关。对整个队列进行 EGE 值的接收者操作特征（ROC）曲线分析。
结果
EMB 显示 34/54 例患者存在心肌炎。标准 EGE 阈值（EGEr>4.0）的敏感性、特异性和准确性值分别为 0.61、0.85 和 0.70。ROC 分析显示 EGEr 的曲线下面积为 0.701（95%CI：0.556-0.846，p=0.014），绝对增强的曲线下面积为 0.706（95%CI：0.563-0.849，p=0.012）。心肌水肿的敏感性、特异性和准确性值分别为 0.67、0.80 和 0.72，LGE 的敏感性、特异性和准确性值分别为 0.76、0.75 和 0.76。
结论
高弛豫性对比剂在诊断心肌炎的 EGE 评估中提供了与标准弛豫性螯合物相当的结果。
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