磁共振成像在心内膜心肌活检阴性心肌炎患者中的诊断价值:回顾性病例系列研究

Role of cardiac magnetic resonance imaging in myocarditis patients with biopsy negative:a retrospective case series study

目的分析临床诊断心肌炎但心内膜心肌活检(EMB)阴性患者的心脏磁共振(CMR)表现,探讨CMR在此类患者中的诊断价值。方法该研究为回顾性分析。纳入符合2013年欧洲心脏病学会(ESC)心肌炎临床诊断标准,但EMB阴性的患者14例。所有患者均行CMR检查,通过黑血序列、电影序列、T2W-STIR序列及钆对比剂延迟增强(LGE)序列,评价心脏的形态学、功能学、组织学改变。结果该研究共纳入14例符合临床诊断标准的心肌炎患者,男10例,女4例,年龄为(25.6±13.2)岁,症状发作至行CMR检查时间间隔为21(13,60)d,症状发作距离EMB检查时间为19(9,40)d。CMR阳性患者13例,表现为心肌水肿、纤维化、射血分数减低、心包积液或心腔增大等。14例患者中共9例患者存在CMR形态和/或功能异常,其中左心房增大1例,左心室增大1例,右心室增大3例,左心室收缩末期容积指数超过正常范围4例,左心室射血分数<50%3例,右心室射血分数<40%5例,心包积液深度>3 mm 3例。14例患者中,有11例存在组织学改变,其中6例患者的T2比值≥2;LGE阳性10例(10/14),最常见的强化模式为左心室侧壁心外膜下和/或室间隔肌壁间(9例),另外左心室壁广泛心内膜下强化2例,无右心室壁强化。结论CMR能够在体评估心脏形态、功能及组织学改变,对于EMB阴性的心肌炎患者,CMR具有良好的补充诊断价值。

Objective To analyze the cardiac magnetic resonance(CMR)imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy(EMB)results,and to further demonstrate the diagnostic value of CMR in these patients.Methods This was a retrospective case series study.Fourteen patients,who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology(ESC)clinical diagnostic criteria for myocarditis,but with negative EMB results,were enrolled.All patients underwent CMR examinations.The morphological,functional and histological changes of the heart were assessed based on black blood sequence,cine sequence,T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE).Results There were 10 males and 4 females in this cohort,the age was(25.6±13.2)years.The interval between symptom onset and CMR was 21(13,60)days,and the interval between symptom onset and EMB was 19(9,40)days.There were 13 patients with abnormal CMR results including myocardial oedema,fibrosis,decreased ejection fraction,pericardial effusion or increased cardiac chamber dimension.Nine out of 14 patients had CMR morphological and/or functional abnormalities,including 1 case of left atrium enlargement,1 case of left ventricle enlargement,3 cases of right ventricle enlargement,4 cases of increased left ventricular end diastolic volume index.Left ventricular ejection fraction was<50%in three cases,right ventricular ejection fraction was<40%in 5 cases,and pericardial effusion depth>3 mm was detected in 3 cases.Of the 14 patients,11 had histological changes,of which 6 had T2 ratio≥2.Among the 10 patients(10/14)with positive LGE,the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum(n=9);2 cases showed extensively subendocardial LGE of the left ventricular wall.No LGE involved in the right ventricular wall in the whole cohort.Conclusion CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.