Friedrich M G, Strohm O, Schulz-Menger J, Marciniak H, Luft F C, Dietz R
Franz-Volhard-Klinik am Max Delbrück Centrum für Molekulare Medizin, Virchow Klinikum, Humboldt Universität zu Berlin, Germany.
Circulation. 1998 May 12;97(18):1802-9. doi: 10.1161/01.cir.97.18.1802.
The course of tissue changes in acute myocarditis in humans is not well understood. Diagnostic tools currently available are unsatisfactory. We tested the hypothesis that inflammation is reflected by signal changes in contrast-enhanced magnetic resonance imaging (MRI).
We assessed 44 consecutive patients with symptoms of acute myocarditis. Nineteen patients met the inclusion criteria revealing ECG changes, reduced myocardial function, elevated creatine kinase, positive troponin T, serological evidence for acute viral infection, exclusion of coronary heart disease, and positive antimyosin scintigraphy. We studied these patients on days 2, 7, 14, 28, and 84 after the onset of symptoms. We obtained ECG-triggered, T1-weighted images before and after application of 0.1 mmol/kg gadolinium. We measured the global relative signal enhancement of the left ventricular myocardium related to skeletal muscle and compared it with measurements in 18 volunteers. The global relative enhancement was higher in patients on days 2 (4.8+/-0.3 [mean+/-SE] versus 2.5+/-0.2; P<.0001); 7 (4.7+/-0.5, P<.0001); 14 (4.6+/-0.5, P<.0002); and 28 (3.9+/-0.4, P=.009) but not on day 84 (3.1+/-0.3; P=NS). On day 2, the enhancement was focal, whereas at later time points, the enhancement was diffuse. In patients with evidence of ongoing disease, the values remained elevated.
Acute myocarditis evolves from a focal to a disseminated process during the first 2 weeks after onset of symptoms. Contrast media-enhanced MRI visualizes the localization, activity, and extent of inflammation and may serve as a powerful noninvasive diagnostic tool in acute myocarditis.
人类急性心肌炎中组织变化的过程尚未完全明了。目前可用的诊断工具并不令人满意。我们检验了这样一个假设，即炎症可通过对比增强磁共振成像（MRI）中的信号变化得以体现。
我们评估了44例连续出现急性心肌炎症状的患者。19例患者符合纳入标准，表现为心电图改变、心肌功能降低、肌酸激酶升高、肌钙蛋白T阳性、急性病毒感染的血清学证据、排除冠心病以及抗肌凝蛋白闪烁显像阳性。我们在症状出现后的第2天、第7天、第14天、第28天和第84天对这些患者进行了研究。在静脉注射0.1 mmol/kg钆对比剂前后，我们获取了心电图触发的T1加权图像。我们测量了左心室心肌相对于骨骼肌的整体相对信号增强，并将其与18名志愿者的测量结果进行比较。在第2天（4.8±0.3[平均值±标准误]对2.5±0.2；P<0.0001）、第7天（4.7±0.5，P<0.0001）、第14天（4.6±0.5，P<0.0002）和第28天（3.9±0.4，P=0.009）患者的整体相对增强较高，但在第84天（3.1±0.3；P=无显著性差异）则不然。在第2天，增强为局灶性，而在随后的时间点，增强为弥漫性。在有疾病持续证据的患者中，数值仍保持升高。
急性心肌炎在症状出现后的前2周内从局灶性过程演变为弥漫性过程。对比剂增强MRI可显示炎症的定位、活性和范围，并可作为急性心肌炎强有力的非侵入性诊断工具。
