Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
J Nucl Cardiol. 2019 Jun;26(3):857-865. doi: 10.1007/s12350-017-1109-3. Epub 2017 Oct 26.
To compare cardiac magnetic resonance (CMR) qualitative and quantitative analysis methods for the noninvasive assessment of myocardial inflammation in patients with suspected acute myocarditis (AM).
A total of 61 patients with suspected AM underwent coronary angiography and CMR. Qualitative analysis was performed applying Lake-Louise Criteria (LLC), followed by quantitative analysis based on the evaluation of edema ratio (ER) and global relative enhancement (RE). Diagnostic performance was assessed for each method by measuring the area under the curves (AUC) of the receiver operating characteristic analyses. The final diagnosis of AM was based on symptoms and signs suggestive of cardiac disease, evidence of myocardial injury as defined by electrocardiogram changes, elevated troponin I, exclusion of coronary artery disease by coronary angiography, and clinical and echocardiographic follow-up at 3 months after admission to the chest pain unit.
In all patients, coronary angiography did not show significant coronary artery stenosis. Troponin I levels and creatine kinase were higher in patients with AM compared to those without (both P < .001). There were no significant differences among LLC, T2-weighted short inversion time inversion recovery (STIR) sequences, early (EGE), and late (LGE) gadolinium-enhancement sequences for diagnosis of AM. The AUC for qualitative (T2-weighted STIR 0.92, EGE 0.87 and LGE 0.88) and quantitative (ER 0.89 and global RE 0.80) analyses were also similar.
Qualitative and quantitative CMR analysis methods show similar diagnostic accuracy for the diagnosis of AM. These findings suggest that a simplified approach using a shortened CMR protocol including only T2-weighted STIR sequences might be useful to rule out AM in patients with acute coronary syndrome and normal coronary angiography.
比较心脏磁共振（CMR）定性和定量分析方法，以无创评估疑似急性心肌炎（AM）患者的心肌炎症。
共 61 例疑似 AM 患者行冠状动脉造影和 CMR 检查。应用 Lake-Louise 标准（LLC）进行定性分析，然后根据水肿比（ER）和整体相对增强（RE）评估进行定量分析。通过测量受试者工作特征分析的曲线下面积（AUC）评估每种方法的诊断性能。根据提示心脏疾病的症状和体征、心电图变化、肌钙蛋白 I 升高提示的心肌损伤证据、冠状动脉造影排除冠状动脉疾病、胸痛单元入院后 3 个月的临床和超声心动图随访，确定 AM 的最终诊断。
所有患者的冠状动脉造影均未显示明显的冠状动脉狭窄。与无 AM 患者相比，AM 患者的肌钙蛋白 I 水平和肌酸激酶更高（均 P<.001）。LLC、T2 加权短反转时间反转恢复（STIR）序列、早期（EGE）和晚期（LGE）钆增强序列在诊断 AM 方面无显著差异。定性（T2 加权 STIR 0.92、EGE 0.87 和 LGE 0.88）和定量（ER 0.89 和整体 RE 0.80）分析的 AUC 也相似。
CMR 定性和定量分析方法对 AM 的诊断具有相似的准确性。这些发现表明，在急性冠状动脉综合征且冠状动脉造影正常的患者中，采用简化方法，仅使用 T2 加权 STIR 序列的缩短 CMR 方案，可能有助于排除 AM。
