Kersten Johannes, Heck Tobias, Tuchek Laura, Rottbauer Wolfgang, Buckert Dominik
Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
J Clin Med. 2020 Nov 25;9(12):3810. doi: 10.3390/jcm9123810.
This prospective single-center study sought to investigate the impact of cardiovascular magnetic resonance (CMR) on the diagnosis of myocarditis, with special attention given to absolute T1 values and defined cutoff values.
All patients referred to our center with the suspicion of an inflammatory myocardial disease were diagnosed by a consensus expert consortium blinded to CMR findings. Classical Lake Louise criteria were then used to confirm or change the diagnosis.
Of a total of 149 patients, 15 were diagnosed with acute myocarditis without taking CMR findings into account. Acute myocarditis was excluded in 91 patients, whereas 42 cases were unclear. Using classical Lake Louise criteria, an additional 35 clear diagnoses were made, either confirming or excluding myocarditis. In the remaining patients, there was no further increase in definitive diagnoses using T1 measurements. The diagnostic performance of T1 mapping in distinguishing acute myocarditis patients from healthy controls was good (area under the curve (AUC) 0.835, cutoff value 1019 ms, sensitivity 73.7%, specificity 72.4%). In the group of patients with suspected and then excluded myocarditis, the cutoff value had a false-positive rate of 56.6%.
Acute myocarditis should be diagnosed on the basis of clinical and imaging factors, whereas T1 mapping could be helpful, especially for excluding acute myocarditis.
这项前瞻性单中心研究旨在调查心血管磁共振成像（CMR）对心肌炎诊断的影响，特别关注绝对T1值和定义的临界值。
所有因疑似炎性心肌疾病转诊至本中心的患者均由对CMR检查结果不知情的专家共识小组进行诊断。然后使用经典的路易斯湖标准来确认或更改诊断。
在总共149例患者中，15例在未考虑CMR检查结果的情况下被诊断为急性心肌炎。91例患者排除急性心肌炎，42例情况不明。使用经典的路易斯湖标准，又做出了35例明确诊断，确诊或排除了心肌炎。在其余患者中，使用T1测量法确诊病例数未进一步增加。T1映射在区分急性心肌炎患者与健康对照方面的诊断性能良好（曲线下面积（AUC）为0.835，临界值为1019毫秒，灵敏度为73.7%，特异性为72.4%）。在疑似心肌炎随后被排除的患者组中，临界值的假阳性率为56.6%。
急性心肌炎应根据临床和影像学因素进行诊断，而T1映射可能会有所帮助，尤其是在排除急性心肌炎方面。
