心脏磁共振在暴发性心肌炎短期随访中的研究

The study of CMR for short-term follow up in fulminant myocarditis

目的:探讨心脏磁共振(CMR)识别及监测暴发性心肌炎患者心肌炎性损伤的价值。方法:19例临床诊断为暴发性心肌炎患者在急性期及随访3个月(愈合期)进行CMR扫描,同期纳入19例正常志愿者作为对照组。CMR序列包括心脏电影、三反转黑血T2WI和延迟增强。测量或计算室间隔厚度、左室心肌质量指数(LVMI)、心肌应变值、水肿比(ER)、延迟强化(LGE)质量等参数。采用Kruskal-Wallis检验比较暴发性心肌炎急性期、愈合期及对照组间各参数的差异。利用ROC曲线分析各参数鉴别急性期和愈合期心肌炎的诊断效能。结果:急性期心肌炎患者的LVMI[64(57,76)g/m2]较愈合期[52(47,63)g/m2]增加(P<0.05)。急性期室间隔厚度[10.5(9,11.3)mm]较愈合期[8.3(6.6,9.8)mm]明显增加(P<0.001)。与急性期相比,愈合期心肌ER[1.66(1.43,1.83)vs 2.35(2.1,3.0)]及LGE质量[4.3(1.04,8.75)g vs 14.52(11.4,22.4)g]均明显减低(P均<0.001)。急性期、愈合期收缩期整体峰值圆周应变(GCS)、径向应变(GRS)、纵向应变(GLS)均明显低于对照组(P均<0.001)。LGE质量和心肌ER鉴别急性期和愈合期心肌炎的诊断效能较高,AUC分别为0.809和0.884。结论:CMR可较准确识别和监测暴发性心肌炎患者心肌炎性损伤,心肌ER及LGE质量鉴别急性期与愈合期心肌炎的效能较高。

Purpose:To evaluate the value of cardiac magnetic resonance(CMR)in detecting and monitoring inflammation myocardial alterations in patients with fulminant myocarditis.Methods:19 patients clinically diagnosised of fulminant myocarditis underwent CMR examination in both acute phase and 3-months follow up(healing phase).The control group consisted of 19 healthy volunteers.The CMR protocol included cardiac film,black blood T2-weighted imaging and delayed gadolinium enhancement(LGE)imaging.Ventricular septal thickness,left ventricular myocardial mass index(LVMI),myocardial strain,edema ratio(ER),LGE mass and other parameters were measured or calculated.The Kruskal-Wallis test were used to compare the difference between the controls group and patients in the acute and healing phase.Receiver operating characteristic(ROC)curves were used to determine the best diagnostic accuracy.Results:Markedly increased LVMI[64(57,76)g/m2 vs 52(47,63)g/m2,P<0.05]and interventricular septum thickness[10.5(9,11.3)mm vs 8.3(6.6,9.8)mm,P<0.001]were found in the patient group in the acute phase.ER[1.66(1.43,1.83)vs 2.35(2.1,3.0),P<0.001]and the LGE mass[4.3(1.04,8.75)g vs 14.52(11.4,22.4)g,P<0.001]were significantly decreased over the course of the disease.The myocardial strain parameters,including global circumferential(GCS),longitudinal(GLS)and radial(GRS)strain in the disease group were significantly lower than those in the control group.The performances of LGE mass and ER were effective in differentiating acute and healing myocarditis,with AUC of 0.809 and 0.884.Conclusion:CMR can detect and monitor inflammatory myocardial injuries in patients with fulminant myocarditis.ER and the LGE mass were more effective in distinguishing acute fulminant myocarditis from healed myocarditis.