心脏MRI诊断儿童急性心肌炎

Cardiac MRI for diagnosis of acute myocarditis in children

目的观察心脏MRI(CMRI)诊断儿童急性心肌炎(AMC)的价值。方法回顾性分析36例临床诊断AMC(AMC组)和22例非心肌炎(对照组)患儿心脏黑血脂肪抑制双反转恢复T2WI、初始T1 mapping及钆对比剂延迟强化成像(LGE),记录其心肌T2信号比、初始T1值,判断LGE阳性与否;比较组间一般资料及CMR参数的差异,绘制受试者工作特征(ROC)曲线,评估单一CMR参数、T2信号比及初始T1值及其联合诊断儿童AMC的效能。结果组间患儿年龄、性别及临床表现、心电图、超声心动图表现差异均无统计学意义(P均>0.05)。AMC组肌酸激酶同工酶[19.00(16.25,24.00)U/L vs.14.00(12.00,16.25)U/L]、N末端B型钠尿肽前体[58.47(30.85,113.75)pg/ml vs.32.94(12.56,84.25)pg/ml]、T2比[2.08(1.57,2.39)vs.1.58(1.36,1.86)]及初始T1值[1326.00(1308.75,1376.50)ms vs.1213.50(1192.75,1243.00)ms]均高于非心肌炎组(P均<0.05),LGE阳性占比(16/36)亦高于非心肌炎组(0/22,P<0.001)。T2信号比、初始T1值及其联合诊断儿童AMC的曲线下面积分别为0.754、0.858及0.902。结论CMRI可有效诊断儿童AMC。

Objective To explore the value of cardiac MRI(CMRI)for diagnosing acute myocarditis(AMC)in children.Methods Data of dark-blood fat suppression double inversion recovery T2WI,initial T1 mapping and late gadolinium enhancement(LGE)imaging of 36 children with clinical diagnosed AMC(AMC group)and 22 children without myocarditis(non-myocarditis group)were retrospectively analyzed.Myocardial T2 signal ratio and native T1 value were recorded,and LGE positive or not was judged.The general data and CMR parameters were compared between groups,and receiver operating characteristic(ROC)curves were drawn to evaluate the efficacy of single CMR parameter,i.e.T2 signal ratio,native T1 value and both for diagnosing AMC in children.Results No significant difference of age,gender,clinical manifestations,electrocardiogram nor echocardiography manifestations was detected between groups(all P>0.05).The level of creatine kinase-MB(19.00[16.25,24.00]U/L vs.14.00[12.00,16.25]U/L),and N-terminal pro-B-type natriuretic peptide(58.47[30.85,113.75]pg/ml vs.32.94[12.56,84.25]pg/ml),T2 signal ratio(2.08[1.57,2.39]vs.1.58[1.36,1.86])and native T1 value(1326.00[1308.75,1376.50]ms vs.1213.50[1192.75,1243.00]ms)in AMC group were all higher than those in non-myocarditis group(all P<0.05).The proportion of LGE positive in AMC group(16/36)was higher than that in non-myocarditis group(0/22,P<0.001).The area under the curve of single T2 signal ratio,initial T1 value and both for diagnosing AMC in children was 0.754,0.858 and 0.902,respectively.Conclusion CMRI could effectively diagnose AMC in children.