Cundari Giulia, Galea Nicola, De Rubeis Gianluca, Frustaci Andrea, Cilia Francesco, Mancuso Giuseppe, Marchitelli Livia, Catapano Federica, Carbone Iacopo, Catalano Carlo, Francone Marco
Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.
Int J Cardiovasc Imaging. 2021 Apr;37(4):1395-1404. doi: 10.1007/s10554-020-02097-9. Epub 2020 Nov 15.
The purpose of our study was to compare diagnostic performance of old and new Lake Louise Criteria (oLLC and nLLC) among different clinical presentations: infarct-like (IL), cardiomyopathic (CM) and arrhythmic (AR). 102 patients with clinical suspicion of acute myocarditis underwent cardiac magnetic resonance (CMR) on a 1.5 T scanner. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping, early and late gadolinium enhancement and T1 mapping acquired before and after gadolinium administration. The degree of agreement has been calculated with Cohen's K test. 42 patients also underwent endomyocardial biopsy (EMB). IL onset was present in 54/102 patients, CM in 28/102 and AR in 20/102. nLLC were positive in 58.3% of the patients, while oLLC in 37.9%, k = 0.57 (IC: 0.428-0.713). The degree of agreement between nLLC and oLLC was 0.49 (IC: 0.111-0.876) for AR onset (nLLC positive in 35% vs oLLC in 15%), 0.25 (IC: 0.035-0.459) for CM pattern (nLLC positive in 60.7% vs oLLC 17.9%) and 0.73 (IC: 0.543-0.912) for IL presentation (nLLC positive in 66.7% vs oLLC in 57.4%). Diagnostic accuracy was 75% for both nLLC and oLLC among IL onset, and 41.6% for oLLC vs 66.7% for nLLC, as regards CM clinical presentation. nLLC have improved diagnostic performance of CMR for the diagnosis of acute myocarditis, in particular for atypical clinical presentation.
我们研究的目的是比较旧版和新版路易斯湖标准（oLLC和nLLC）在不同临床表现中的诊断性能：梗死样（IL）、心肌病样（CM）和心律失常样（AR）。102例临床怀疑急性心肌炎的患者在1.5T扫描仪上接受了心脏磁共振成像（CMR）检查。检查方案包括稳态自由进动序列（cine-SSFP）、T2加权短反转恢复序列（T2-weighted STIR）、T2 mapping、钆剂早期和延迟强化以及钆剂注射前后的T1 mapping。采用Cohen's K检验计算一致性程度。42例患者还接受了心内膜心肌活检（EMB）。102例患者中，54例为IL起病，28例为CM起病，20例为AR起病。nLLC在58.3%的患者中呈阳性，而oLLC在37.9%的患者中呈阳性，k = 0.57（95%置信区间：0.428 - 0.713）。对于AR起病，nLLC和oLLC之间的一致性程度为0.49（95%置信区间：0.111 - 0.876）（nLLC阳性率为35%，oLLC为15%）；对于CM模式，一致性程度为0.25（95%置信区间：0.035 - 0.459）（nLLC阳性率为60.7%，oLLC为17.9%）；对于IL表现，一致性程度为0.73（95%置信区间：0.543 - 0.912）（nLLC阳性率为66.7%，oLLC为57.4%）。在IL起病的患者中，nLLC和oLLC的诊断准确率均为75%；在CM临床表现方面，oLLC的诊断准确率为41.6%，而nLLC为66.7%。nLLC提高了CMR对急性心肌炎诊断的性能，特别是对于非典型临床表现。
