心脏磁共振定量组织标记技术对急性心肌炎的诊断价值

摘要

Objective To explore the value of cardiac magnetic resonance (CMR) quantitative tissuetracking in diagnosis of acute myocarditis.Methods Thirty-five patients diagnosed of acute myocarditis and thirty-five healthy volunteers from February 2014 to October 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled.All patients were scanned magnetic resonance CINE,T1 and T2 mapping,early gadolinium enhancement(EGE) and late gadolinium enhancement (LGE) sequences to evaluate the diagnostic efficiency.Results T1 relaxation time,T2 relaxation time,T2 signal intensity ratio and EGE ratio in patients with acute myocarditis were significantly higher than those in healthy people [(1 310 ± 62) ms vs (1 247 ± 27) ms,(65 ± 8)ms vs (55 ±4)ms,(1.85 ±0.21)％ vs (1.58 ±0.15)％,(3.9 ± 1.6)％ vs (2.1 ± 1.4)％] (P ＜0.05).Healthy people did not show LGE;35 patients with acute myocarditis showed 47 myocardial segments of LGE located in epicardium 21 sites (44.7％),midmyocardium 22 sites (46.8％),side wall 22 sites (46.8％) and inferior wall 23 sites(48.9％).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the diagnosis of acute myocarditis through T1 relaxation time in combination with T2 relaxation time were higher than those diagnosed by the Lake-Louise Criteria (90.5％ vs 81.4％,100.0％ vs 96.6％,95.5％ vs 93.3％,100.0％ vs 95.4％,93.4％ vs 88.5％).Conclusion CMR quantitative tissue-tracking has good diagnostic efficiency for acute myocarditis.%目的 探讨心脏磁共振(CMR)定量组织标记技术对急性心肌炎的诊断价值.方法 选择2014年2月至2015年10月于首都医科大学附属北京安贞医院治疗的急性心肌炎患者35例(急性心肌炎组)和35名健康志愿者(对照组),分别行电影(CINE)、黑血T2、T2mapping、初始及打药后的T1 mapping、钆对比剂早期强化(EGE)和钆对比剂延迟强化(LGE)序列扫描,对比分析T1、T2弛豫时间、T2信号强度比、早期强化率、LGE出现部位及各种方法的诊断效能.结果 急性心肌炎组的T1弛豫时间、T2弛豫时间、T2信号强度比和早期强化率均明显高于对照组[(1 310±62) ms比(1 247±27) ms、(65 ±8)ms比(55±4)ms、(1.85±0.21)％比(1.58 ±0.15)％、(3.9±1.6)％比(2.1±1.4)％],差异均有统计学意义(均P＜0.05).对照组没有出现LGE,急性心肌炎组47个心肌节段出现LGE,其中位于心外膜下21处(44.7％)和心肌中层22处(46.8％),侧壁22处(46.8％)和下壁23处(48.9％),没有出现单独的心内膜下LGE类型.T1、T2弛豫时间联合应用时,诊断急性心肌炎的敏感度、特异度、准确率、阳性预测值、阴性预测值均高于路易斯湖诊断标准(90.5％比81.4％、100.0％比96.6％、95.5％比93.3％、100.0％比95.4％、93.4％比88.5％).结论 CMR定量组织标记技术对急性心肌炎有很好的诊断价值,对于造影剂有禁忌的患者,将有可能取代路易斯湖诊断技术.