Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Radiol. 2023 Sep;33(9):6258-6266. doi: 10.1007/s00330-023-09905-5. Epub 2023 Jul 12.
Parametric cardiac magnetic resonance (CMR) techniques have improved the diagnosis of pathologies. However, the primary tool for differentiating non-ST elevation myocardial infarction (NSTEMI) from myocarditis is still a visual assessment of conventional signal-intensity-based images. This study aimed at analyzing the ability of parametric compared to conventional techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns.
Twenty NSTEMI patients, twenty infarct-like myocarditis patients, and twenty controls were examined using cine, T2-weighted CMR (T2w) and late gadolinium enhancement (LGE) imaging and T1/T2 mapping on a 1.5 T scanner. CMR images were presented in random order to two experienced fully blinded observers, who had to assign them to three categories by a visual analysis: NSTEMI, myocarditis, or healthy.
The conventional approach (cine, T2w and LGE combined) had the best diagnostic accuracy with 92% (95%CI: 81-97) for NSTEMI and 86% (95%CI: 71-94) for myocarditis. The diagnostic accuracies using T1 maps were 88% (95%CI: 74-95) and 80% (95%CI: 62-91), 84% (95%CI: 67-93) and 74% (95%CI: 54-87) for LGE, and 83% (95%CI: 66-92) and 73% (95%CI: 53-87) for T2w. The accuracies for cine (72% (95%CI: 52-86) and 60% (95%CI: 38-78)) and T2 maps (62% (95%CI: 40-79) and 47% (95%CI: 28-68)) were significantly lower compared to the conventional approach (p < 0.001 and p < 0.0001).
The conventional approach provided a reliable visual discrimination between NSTEMI, myocarditis, and controls. The diagnostic accuracy of a visual pattern analysis of T1 maps was not significantly inferior, whereas the diagnostic accuracy of T2 maps was not sufficient in this context.
The ability of parametric compared to conventional CMR techniques to visually differentiate ischemic from non-ischemic myocardial injury patterns can avoid potentially unnecessary invasive coronary angiography and help to shorten CMR protocols and to reduce the need of gadolinium contrast agents.
• A visual differentiation of ischemic from non-ischemic patterns of myocardial injury is reliably achieved by a combination of conventional CMR techniques (cine, T2-weighted and LGE imaging). • There is no significant difference in accuracies between visual pattern analysis on native T1 maps without providing quantitative values and a conventional combined approach for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls. • T2 maps do not provide a sufficient diagnostic accuracy for visual pattern analysis for differentiating non-ST elevation myocardial infarction, infarct-like myocarditis, and controls.
参数化心脏磁共振（CMR）技术提高了对病变的诊断能力。然而，区分非 ST 段抬高型心肌梗死（NSTEMI）与心肌炎的主要工具仍然是基于常规信号强度的图像的视觉评估。本研究旨在分析参数化技术与常规技术相比在视觉上区分缺血性与非缺血性心肌损伤模式的能力。
20 名 NSTEMI 患者、20 名类似梗死性心肌炎患者和 20 名对照者在 1.5T 扫描仪上接受电影、T2 加权 CMR（T2w）和晚期钆增强（LGE）成像以及 T1/T2 映射检查。CMR 图像以随机顺序呈现给两位经验丰富的完全盲法观察者，他们必须通过视觉分析将其分为三类：NSTEMI、心肌炎或健康。
常规方法（电影、T2w 和 LGE 结合）对 NSTEMI 和心肌炎的诊断准确性最佳，分别为 92%（95%CI：81-97）和 86%（95%CI：71-94）。使用 T1 图谱的诊断准确性分别为 88%（95%CI：74-95）和 80%（95%CI：62-91）、84%（95%CI：67-93）和 74%（95%CI：54-87），LGE 和 83%（95%CI：66-92）和 73%（95%CI：53-87），T2w。电影（72%（95%CI：52-86）和 60%（95%CI：38-78））和 T2 图谱（62%（95%CI：40-79）和 47%（95%CI：28-68））的准确性明显低于常规方法（p<0.001 和 p<0.0001）。
常规方法可可靠地区分 NSTEMI、心肌炎和对照组之间的差异。T1 图谱的视觉模式分析的诊断准确性没有显著差异，而在这种情况下 T2 图谱的诊断准确性不足。
与常规 CMR 技术相比，参数化技术能够在视觉上区分缺血性与非缺血性心肌损伤模式，从而可以避免潜在的不必要的冠状动脉造影，并有助于缩短 CMR 方案和减少对钆造影剂的需求。
常规 CMR 技术（电影、T2w 和 LGE 成像）的组合可可靠地区分缺血性与非缺血性心肌损伤模式。
与区分 NSTEMI、类似梗死性心肌炎和对照组的常规联合方法相比，无提供定量值的原始 T1 图谱的视觉模式分析的准确性没有显著差异。
T2 图谱的视觉模式分析无法提供足够的诊断准确性来区分 NSTEMI、类似梗死性心肌炎和对照组。
