Stukalova O V, Gupalo E M, Chumachenko P V, Samko A N, Butorova E A, Shakhnovich R M, Mironova N A, Narusov O Yu, Safiullina A A, Shariya M A, Golitsyn S P, Ternovoy S K, Chazova I E
A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center of Cardiology of the Ministry of Health of Russia, Moscow, Russia.
I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russia.
Ter Arkh. 2019 May 16;91(4):28-36. doi: 10.26442/00403660.2019.04.000078.
to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis.
11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed.
According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively).
CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.
评估心脏磁共振成像（CMR）在心肌炎各种临床类型中的诊断意义。
11例（8例男性，平均年龄32.8±11.1岁）因疑似急性冠状动脉综合征住院的患者（第I组），检查期间排除了急性心肌梗死；48例（31例男性，43.1±12.7岁）有扩张型心肌病（DCM）临床和器械检查体征的患者（第II组）；以及20例（12例男性，39.5±14岁）有室性心动过速发作的患者（第III组）接受了心脏磁共振成像（CMRI）检查。38例患者进行了心内膜心肌活检（EMB）。
根据EMB结果，第II组10例（34.5%）患者和第III组3例（37.5%）患者有活动性心肌炎体征；第II组8例（27.6%）患者和第III组3例（37.5%）患者有已愈心肌炎体征；第II组11例（37.9%）患者和第III组2例（25%）患者有最小形态学改变。第I组9例（81.9%）患者的MRI数据可确诊急性心肌炎。第II组患者中5例（10.4%）心肌有MRI数据显示的活动性炎症体征，第III组患者中有7例（35%）。第II组22例（45.8%）患者和第III组10例（50%）患者的CMR数据符合已愈心肌炎表现。第II组21例（43.8%）患者和第III组3例（15%）患者的MRI显示最小结构改变。对于有DCM临床和器械检查体征及/或室性心动过速的患者，MRI可识别“活动性心肌炎 ”体征，敏感性为37.5%，特异性为83.4%。同时，对于已愈心肌炎和最小形态学改变的病例，MRI具有高敏感性（分别为70%和71.5%）和特异性（分别为71.5%和75%）。
CMR在心肌炎梗死样病程患者中具有高诊断意义。在有扩张型心肌病或心律失常临床综合征的患者中，MRI检测活动性心肌炎的敏感性低（37.5%），但特异性高（83.4%）。在心肌最小结构改变和炎症已愈的病例中，CMR是EMB的良好替代方法。
