磁共振在急性病毒性心肌炎中的诊断价值  

Diagnostic value of cardiac magnetic resonance in patients with acute viral myocarditis

作　　者：欧阳海春 陈海雄[2] 胡允兆 吴焱贤 黎文生 陈玉映 岑玉坚[2] 

机构地区：[1]广东省佛山市顺德区第一人民医院心血管内科,528300 [2]广东省佛山市顺德区第一人民医院放射科,528300

出　　处：《中华心血管病杂志》2014年第11期927-931,共5页Chinese Journal of Cardiology

基　　金：广东省企业技术研发与升级改造专项资金（2013B021800116）;广东省佛山市医学类科学攻关项目（201208215）

摘　　要：目的 探讨磁共振在急性病毒性心肌炎中的诊断价值.方法 2011年6月至2013年6月,入选佛山市顺德区第一人民医院的疑似急性病毒性心肌炎患者30例进行前瞻性研究.以临床诊断作为参照,评价磁共振诊断急性病毒性心肌炎的灵敏度、特异度、阳性预测值、阴性预测值及准确度,并对比不同的磁共振扫描方法和路易斯湖标准在急性病毒性心肌炎中的诊断价值.结果 在30例疑似患者中,19例（63.33％）临床诊断为急性病毒性心肌炎.诊断急性病毒性心肌炎的灵敏度、特异度、阳性预测值、阴性预测值和准确度磁共振心肌水肿比（ER）分别为57.89％、72.73％、78.57％、50.00％和63.33％,磁共振心肌早期钆增强成像技术计算的全心肌相对增强（gRE）分别为78.95％、63.64％、78.95％、63.64％和73.33％,磁共振心肌延迟强化成像（LGE）分别为78.95％、54.55％、75.00％、60.00％和70.00％,磁共振路易斯湖标准分别为84.21％、81.82％、88.89％、75.00％和83.33％.磁共振路易斯湖标准的灵敏度、特异度、阳性预测值、阴性预测值和准确度均高于其他3种扫描方法（P均＜0.05）;ER的特异度高于gRE和LGE（P均＜0.05）;gRE的灵敏度、阴性预测值、准确度均高于ER（P均＜0.05）,与LGE比较差异无统计学意义（P均＞0.05）.结论 磁共振在急性病毒性心肌炎中有较高的诊断价值.Objective To assess the diagnostic value of cardiac magnetic resonance （CMR） in patients with acute viral myocarditis.Methods Thirty patients with suspected acute viral myocarditis admitted in first people＇s hospital of Shunde from June 2011 to June 2013 were included in this prospective study.The diagnostic sensitivity,specificity,positive predictive value （PPV）,negative predictive value （NPV） and accuracy of acute viral myocarditis were evaluated by clinical diagnosis.Diagnostic value among different scan methods and Lake Louise criteria were compared.Results Acute viral myocarditis was diagnosed in 63.33％ （19/30） patients.Values for sensitivity,specificity,PPV,NPV,and diagnostic accuracy within the overall cohort were 57.89％,72.73％,78.57％,50.00％,63.33％,respectively by edema imaging（ER）.Values for sensitivity,specificity,PPV,NPV,and diagnostic accuracy within the overall cohort were 78.95％,63.64％,78.95％,63.64％,73.33％,respectively using global relative enhancement （gRE）.Values for sensitivity,specificity,PPV,NPV,and diagnostic accuracy within the overall cohort were 78.95％,54.55％,75.00％,60.00％,70.00％,respectively using late gadolinium enhancement （LGE） criteria.Values for sensitivity,specificity,PPV,NPV,and diagnostic accuracy within the overall cohort were 84.21％,81.82％,88.89％,75.00％,83.33％ using Lake Louise criteria.The sensitivity,specificity,PPV,NPV,and diagnostic accuracy using Lake Louise criteria were significantly higher than using ER,gRE,LGE alone （all P ＜ 0.05）.Specificity was higher using ER than using gRE and LGE（both P ＜ 0.05）.The sensitivity,NPV,and diagnostic accuracy were significantly higher using gRE than using ER （all P ＜ 0.05） and was similar as using LGE （all P ＞ 0.05）.Conclusion Cardiac magnetic resonance is an excellent imaging modality for the diagnosis of acute viral myocarditis.

关 键 词：心肌炎 磁共振成像 诊断 

分 类 号：R445.2[医药卫生—影像医学与核医学]