Vaikom House Aswathy, Grosse-Wortmann Lars
Section of Pediatric Cardiology, Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.
Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
Cardiovasc Diagn Ther. 2025 Aug 30;15(4):888-897. doi: 10.21037/cdt-24-502. Epub 2025 Aug 28.
Cardiac magnetic resonance (CMR) imaging has become a crucial diagnostic and prognostic tool for assessing myocardial health, especially in pediatric patients with congenital heart disease. This review focuses on the role of CMR in myocardial tissue characterization, particularly its ability to detect and quantify fibrosis using techniques such as late gadolinium enhancement (LGE), T1 and T2 mapping, and extra-cellular volume (ECV) measurements. CMR offers superior anatomical and functional information, complementing traditional imaging modalities by enabling detailed visualization of native myocardial edema, interstitial fibrosis, and other tissue changes. These advanced imaging techniques are particularly useful in diagnosing conditions such as myocarditis, cardiac allograft rejection, Kawasaki disease (KD), and other cardiomyopathic processes. In pediatric myocarditis, CMR has demonstrated strong diagnostic utility, with T1 and ECV values helping to differentiate between healthy controls and patients with acute myocarditis, while also predicting disease severity and outcomes. In the context of cardiac transplant, T1 mapping, shows promise in detecting early signs of rejection, providing a less invasive alternative to endomyocardial biopsy. Additionally, CMR has been employed to monitor myocardial damage in KD, where it detects increased ECV in both coronary-affected and remote myocardial areas. The review also discusses CMR's application in tracking myocardial fibrosis in pediatric cardiomyopathies, highlighting its potential as a prognostic marker for heart failure progression. Despite its advantages, challenges remain in standardizing imaging protocols across disease states and establishing comprehensive guidelines for routine use. The future of CMR in pediatric cardiology lies in its ability to improve early diagnosis, guide personalized treatment, and enhance long-term monitoring of heart conditions, ultimately improving patient outcomes.
心脏磁共振成像（CMR）已成为评估心肌健康的关键诊断和预后工具，尤其是在患有先天性心脏病的儿科患者中。本综述重点关注CMR在心肌组织特征分析中的作用，特别是其使用延迟钆增强（LGE）、T1和T2映射以及细胞外容积（ECV）测量等技术检测和量化纤维化的能力。CMR提供了卓越的解剖和功能信息，通过详细显示原生心肌水肿、间质纤维化和其他组织变化来补充传统成像方式。这些先进的成像技术在诊断心肌炎、心脏移植排斥反应、川崎病（KD）和其他心肌病过程等病症中特别有用。在儿科心肌炎中，CMR已显示出强大的诊断效用，T1和ECV值有助于区分健康对照和急性心肌炎患者，同时还能预测疾病严重程度和预后。在心脏移植方面，T1映射在检测排斥反应的早期迹象方面显示出前景，为心内膜心肌活检提供了一种侵入性较小的替代方法。此外，CMR已被用于监测KD中的心肌损伤，它在受冠状动脉影响和远端心肌区域均检测到ECV增加。该综述还讨论了CMR在追踪儿科心肌病中心肌纤维化方面的应用，强调了其作为心力衰竭进展预后标志物的潜力。尽管具有优势，但在跨疾病状态标准化成像方案以及建立常规使用的综合指南方面仍存在挑战。儿科心脏病学中CMR的未来在于其改善早期诊断、指导个性化治疗以及加强心脏疾病长期监测的能力，最终改善患者预后。
