目的 探讨心脏磁共振成像对急性冠状动脉综合征表现为主的病毒性心肌炎的诊断价值.材料与方法 收集2013年1月至2016年12月黔江中心医院心内科收治冠状动脉造影阴性的高度疑似急性病毒性心肌炎患者16例及缺血性心脏病患者5例入选本研究,行心电门控的心脏磁共振检查,扫描序列包括T2加权成像、Turbo FLASH序列、早期钆强化及延迟钆强化序列,收集数据并统计分析.结果 采用心脏磁共振成像检查对急性冠状动脉综合征表现为主的高度疑似病毒性心肌炎和同期缺血性心脏病以路易斯湖标准为基础的影像学评分比较显示,与对照组比较,延迟钆强化序列、T2加权成像和路易斯湖标准总评分显著增加,差异具有统计学意义(P=0.021、0.011、0.002);受试者工作特征曲线显示,路易斯湖标准总评分的最佳截断值为6.12,敏感性为93.8%,特异性为80.0%,与Turbo FLASH序列、早期钆强化率、延迟钆强化序列、T2加权成像比较,路易斯湖标准总评分的诊断效能比较均衡;延迟钆强化指标的特异性为100%,T2WI的敏感性为93.8%.结论 路易斯湖标准对于急性冠状动脉综合征表现为主的病毒性心肌炎具有无创影像学鉴别价值,同时延迟钆强化序列具有较高的特异性,T2加权成像具有较高的敏感性,可用于缺血性心脏病的鉴别诊断.%Objective: To evaluate the value of cardiac magnetic resonance imaging in the diagnosis of viral myocarditis with the main symptoms of acute coronary syndrome. Materials and Methods: Sixteen cases of highly suspected acute viral myocarditis with negative coronary angiography and five cases of ischemic heart disease as the control were included into this study from January of 2013 to December of 2016 in the department of cardiology, Chongqing Qianjiang central hospital; all the selected patients underwent electrocardiogram-gated magnetic resonance imaging with the scan sequences including T2 weighted imaging (T2WI), turbo FLASH sequence, early gadolinium enhanced (EGE) ratio and late gadolinium enhanced (LGE) sequence, and the data of above sequences were collected and statistically analysed. Results: The scores of T2WI, LGE and overall Lake Louise Criteria significantly increased in viral myocarditis with the main symptoms of acute coronary syndrome comparing to the control by using cardiac magnetic resonance (P=0.021, 0.011, 0.002);receiver operating characteristic curves showed that the best cut-off value of Lake Lewis Criteria score was 6.12, the sensitivity was 93.8%, specificity was 80%; comparing with Turbo FLASH sequence, EGE ratio, LGE, and T2WI, diagnostic efficacy of Lake Lewis Criteria score was balanced; the specificity of LGE was 100%, and the sensitivity of T2WI was 93.8%. Conclusion: Lake Lewis criteria may be an effective and non-invasive tool for the diagnosis of viral myocarditis with the main symptoms of acute coronary syndrom; and MRI-LGE sequence with good specificity and MRI-T2WI sequence with good sensitivity could be used for the differential diagnosis of ischemic heart disease.
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