Department of Cardiology, St James Hospital, James Street, Dublin 8, Republic of Ireland.
Curr Cardiol Rep. 2020 May 29;22(7):47. doi: 10.1007/s11886-020-01295-0.
This review was undertaken to summarise recent data relating to T1 and T2 relaxation times in the assessment of myocarditis using cardiac MRI, and the effect new studies have had on the established diagnostic criteria, leading to recently proposed revised criteria for the cardiac MRI assessment of myocarditis.
In 2018, updates to the 2009 Lake Louise Criteria (LLC) were proposed, based on studies showing improved accuracy of T1 mapping techniques over T1 signal intensity ratio-based imaging, although for the detection of myocardial oedema either T2-weighted images or increased T2 relaxation times can be used. Non-ischaemic distribution of scar on late gadolinium-enhanced (LGE) T1-weighted imaging remains in the newly revised criteria, which, although can have low sensitivity due to fibrosis presenting diffusely or due to CMR being performed early in the disease process before scar formation, remains in the LLC due to its high specificity. Early gadolinium enhancement has been removed from the LLC, as T1 quantification has higher diagnostic accuracy for the detection of myocardial injury. In the CMR assessment of myocarditis, T1 and T2 quantifications are now recommended over T1- and T2-weighted imaging. Late gadolinium enhancement in a non-ischaemic pattern remains in the updated criteria, whereas early gadolinium enhancement has been superseded by T1 quantification.
本综述旨在总结心脏 MRI 评估心肌炎时 T1 和 T2 弛豫时间的最新数据，以及新研究对既定诊断标准的影响，从而提出最近提出的用于心脏 MRI 评估心肌炎的修订标准。
2018 年，基于 T1 映射技术比 T1 信号强度比成像具有更高准确性的研究，对 2009 年的莱克路易斯标准（LLC）进行了更新，尽管对于检测心肌水肿，既可以使用 T2 加权图像，也可以使用增加的 T2 弛豫时间。在新修订的标准中，钆延迟增强（LGE）T1 加权成像上的非缺血性瘢痕分布仍然存在，尽管由于纤维化呈弥漫性或由于 CMR 在疾病过程早期进行，即在瘢痕形成之前进行，因此其敏感性可能较低，但由于其特异性较高，因此仍在 LLC 中。由于 T1 定量对心肌损伤的检测具有更高的诊断准确性，因此 LLC 已不再包含早期钆增强。在心肌炎的 CMR 评估中，现在推荐 T1 和 T2 定量而不是 T1 和 T2 加权成像。非缺血模式中的晚期钆增强仍然存在于更新后的标准中，而早期钆增强已被 T1 定量所取代。
