Chen Zhiyong, Xing Zhangli, Zheng Enshuang, Xue Yunjing, Sun Bin
Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
Quant Imaging Med Surg. 2025 Jul 1;15(7):6414-6425. doi: 10.21037/qims-24-2293. Epub 2025 Jun 24.
Early gadolinium enhancement (EGE) assessment for myocardial hyperemia is generally considered the least robust of the three Lake Louis Criteria (LLC), which is attributable to the limitations of the technique. The purpose of this study was to assess the feasibility of the contrast-enhanced whole-heart magnetic resonance imaging (CE WH-MRI) as a novel method for the diagnosis of acute myocarditis.
We retrospectively reviewed the data of 54 patients admitted to Fujian Medical University Union Hospital between May 2020 to March 2024 with clinically suspected acute myocarditis. The diagnostic guidelines established by the European Society of Cardiology (ESC) were applied in this study. Additionally, we included 43 healthy individuals as controls. The hyperintense areas in the late gadolinium enhancement (LGE) and CE WH-MRI images were doubtfully or reliably interpreted by the two observers. The left ventricular (LV) myocardium was divided into 17 segments according to American Heart Association (AHA) consensus, which allowed us to evaluate the presence of hyperemia-weighted patterns or LGE.
The final population included 43 patients. The acquisition time of CE WH-MRI was 8.2±1.3 min. Myocardial hyperemia-weighted patterns in CE WH-MRI images were found in 41 of 43 (95.35%) participants. LGE was detected in 29 of 43 (67.44%) patients. Comparative analysis between CE WH-MRI and two-dimensional LGE sequences revealed myocardial involvement in 322 and 210 segments, respectively.
This study established the viability of CE WH-MRI in identifying myocardial hyperemia-weighted patterns among patients with acute myocarditis. Additionally, through the combination of quantitative cardiac magnetic resonance (CMR) with the established LLC, CE WH-MRI could provide additive value in enhancing the accuracy of acute myocarditis diagnosis.
早期钆增强（EGE）评估心肌充血通常被认为是路易斯湖标准（LLC）三项指标中最不可靠的一项，这归因于该技术的局限性。本研究的目的是评估对比增强全心磁共振成像（CE WH-MRI）作为诊断急性心肌炎的新方法的可行性。
我们回顾性分析了2020年5月至2024年3月间福建医科大学附属协和医院收治的54例临床疑似急性心肌炎患者的数据。本研究采用了欧洲心脏病学会（ESC）制定的诊断指南。此外，我们纳入了43名健康个体作为对照。两名观察者对钆延迟增强（LGE）和CE WH-MRI图像中的高信号区域进行了可疑或可靠的解读。根据美国心脏协会（AHA）的共识，将左心室（LV）心肌分为17个节段，这使我们能够评估充血加权模式或LGE的存在情况。
最终纳入43例患者。CE WH-MRI的采集时间为8.2±1.3分钟。43名参与者中有41名（95.35%）在CE WH-MRI图像中发现了心肌充血加权模式。43例患者中有29例（67.44%）检测到LGE。CE WH-MRI与二维LGE序列的对比分析显示，心肌受累节段分别为322个和210个。
本研究证实了CE WH-MRI在识别急性心肌炎患者心肌充血加权模式方面的可行性。此外，通过将定量心脏磁共振（CMR）与既定的LLC相结合，CE WH-MRI在提高急性心肌炎诊断准确性方面可以提供附加价值。
