From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.).
Radiology. 2019 Sep;292(3):608-617. doi: 10.1148/radiol.2019190101. Epub 2019 Jul 30.
BackgroundThe establishment of a timely and correct diagnosis in heart failure-like myocarditis remains one of the most challenging in clinical cardiology.PurposeTo assess the diagnostic potential of texture analysis in heart failure-like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard.Materials and MethodsSeventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial (ClinicalTrials.gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1.5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 and T2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation.ResultsIn participants with acute heart failure-like myocarditis ( = 31; mean age, 47 years ± 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2_GLNU) showed diagnostic performance similar to that of mean myocardial T2 time (AUC, 0.69 for both). The combination of mean T2 time and T2_GLNU had the highest AUC (0.76; 95% confidence interval [CI]: 0.43, 0.95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure-like myocarditis ( = 40; mean age, 48 years ± 13; 12 women), the histogram feature T2_kurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0.81; 95% CI: 0.66, 0.96). The combination of the two texture features, T2_kurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0.85; 95% CI: 0.57, 0.90; sensitivity, 90% [36 of 40]; and specificity, 72% [29 of 40]).ConclusionIn this proof-of-concept study, texture analysis applied on cardiac MRI T1 and T2 mapping delivers quantitative imaging parameters for the diagnosis of acute or chronic heart failure-like myocarditis and might be superior to Lake Louise criteria or averaged myocardial T1 or T2 values.© RSNA, 2019See also the editorial by de Roos in this issue.
在心力衰竭样心肌炎中建立及时和正确的诊断仍然是临床心脏病学中最具挑战性的问题之一。
评估纹理分析在心力衰竭样心肌炎诊断中的潜力，并与作为参考标准的心肌活检（EMB）进行比较。
前瞻性纳入 71 名来自心肌磁共振成像心肌炎研究（MyoRacer）试验（ClinicalTrials.gov 注册号：NCT02177630）的研究参与者，这些参与者具有心肌炎的临床疑似症状和心力衰竭的症状（2012 年 8 月至 2015 年 5 月）。参与者接受了双心室 EMB 和 1.5 T 的心脏 MRI，包括本地 T1 和 T2 映射和标准的路易丝湖标准。使用开源软件对 T1 和 T2 图谱进行纹理分析。通过逐步降维选择能够诊断心肌炎的特征。通过 10 倍交叉验证的接收者操作特征分析评估诊断性能，并计算曲线下面积（AUC）。
在患有急性心力衰竭样心肌炎的参与者中（n=31；平均年龄为 47 岁±17；10 名女性），T2 图谱的灰度不均匀度（T2_GLNU）纹理特征的诊断性能与平均心肌 T2 时间相似（AUC 均为 0.69）。平均 T2 时间和 T2_GLNU 的组合具有最高的 AUC（0.76；95%置信区间[CI]：0.43，0.95），其灵敏度为 81%（25/31），特异性为 71%（22/31）。在患有慢性心力衰竭样心肌炎的患者中（n=40；平均年龄为 48 岁±13；12 名女性），直方图特征 T2 峰度与其他所有单一参数相比具有更高的诊断性能（AUC：0.81；95%CI：0.66，0.96）。两个纹理特征，即 T2 峰度和 T1 的灰度不均匀度的组合具有最高的诊断性能（AUC：0.85；95%CI：0.57，0.90；灵敏度：90%[36/40]；特异性：72%[29/40]）。
在这项概念验证研究中，应用于心脏 MRI T1 和 T2 映射的纹理分析可提供用于诊断急性或慢性心力衰竭样心肌炎的定量成像参数，其可能优于路易丝湖标准或平均心肌 T1 或 T2 值。
© RSNA，2019
另见本期社论 de Roos 的文章。
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