定量多参数CMR在识别及监测暴发性心肌炎心肌水肿的研究  

Study of quantitative multiparametric CMR in the detection and monitoring of myocardial edema in fulminant myocarditis

作　　者：李浩杰 朱慧 夏黎明[1] LI Haojie;ZHU Hui;XIA Liming(Department of Radiology,Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科

出　　处：《磁共振成像》2019年第12期899-903,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金(编号：81873889)~~

摘　　要：目的评估定量多参数心脏磁共振(cardiac magnetic resonance,CMR)在识别及监测暴发性心肌炎患者心肌炎性损伤的价值。材料与方法19例临床诊断为暴发性心肌炎患者急性期及随访3个月在3.0 T MR上进行CMR扫描,19名正常志愿者作为对照组。CMR扫描方案包括心脏电影、黑血T2WI、T1 mapping、T2 mapping、延迟强化。在心脏常规电影上进行心肌应变分析。结果与急性期相比,暴发性心肌炎愈合期整体原始T1[1414(1357,1459)vs 1267(1249,1298),P<0.001]、T2[47(43,49)vs39(38,43),P<0.001]及细胞外容积(extracellular volume,ECV)[0.36(0.32,0.40)vs0.29(0.26,0.30),P<0.001]值明显减低,但明显高于正常对照组。急性期患者长轴、圆周及径向应变均明显低于正常对照组。原始T1及T2值鉴别急性期与愈合期心肌炎效能较高,受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)值分别为0.947与0.931。结论定量多参数CMR较准确识别及监测暴发性心肌炎患者心肌炎性损伤。原始T1及T2值鉴别急性期与愈合期心肌炎效能较高。Objective:To assess quantitative multiparametric cardiac magnetic resonance(CMR)to detect and monitor inflammation myocardial injuries in fulminant myocarditis.Materials and Methods:19 patients with clinical diagnosis of fulminant myocarditis underwent CMR examination at 3.0 T in the acute phase and at 3-months follow up.The control group consisted of 19 healthy volunteers.The CMR protocol included cine,black blood T2-weighted imaging,T1 mapping,T2 mapping and late gadolinium enhancement(LGE).Myocardial strain analysis was performed on routine cine images.Results:Compared with patients with acute fulminant myocarditis,native T1[1414(1357,1459)vs 1267(1249,1298),P<0.001],T2[47(43,49)vs 39(38,43),P<0.001]and ECV[0.36(0.32,0.40)vs 0.29(0.26,0.30),P<0.001]were markedly reduced in the follow-up scan,but still elevated compared to healthy controls.Compared with the controls,strain indices were all significantly impaired in acute stage.Native T1 and T2 values led to excellent diagnostic accuracy for discriminating acute myocarditis from healed myocarditis,with AUC of 0.947 and 0.931.Conclusions:Quantitative multiarametric CMR can accurately detect and monitor inflammatory myocardial injuries in patients with fulminant myocarditis.Native T1 and T2 values achieved excellent diagnostic performance in distinguishing acute from healed myocarditis.

关 键 词：磁共振成像 心肌炎 应变 心脏磁共振 

分 类 号：R445.2[医药卫生—影像医学与核医学] R542.21[医药卫生—诊断学]