心脏MR鉴别急性病毒性心肌炎与特发性炎性肌病心肌受累  

Cardiac MR in differentiating acute viral myocarditis from myocardial involvement in idiopathic inflammatory myopathy

作　　者：冯长静 刘王琰 孙晓萱[2] 王嫱[2] 朱晓梅[1] 徐怡[1] 祝因苏[1] FENG Changjing;LIU Wangyan;SUN Xiaoxuan;WANG Qiang;ZHU Xiaomei;XU Yi;ZHU Yinsu(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Rheumatology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京医科大学第一附属医院风湿免疫科,江苏南京210029

出　　处：《实用放射学杂志》2022年第2期222-226,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(81601464,61871117).

摘　　要：目的探讨心脏磁共振(CMR)成像在鉴别急性病毒性心肌炎(AVM)与特发性炎性肌病(IIM)心肌受累中的应用价值.方法回顾性分析经临床证实的29例IIM及24例AVM患者临床及CMR参数.CMR参数包括左心形态功能参数及心肌组织特征成像参数,如初始T1值、T2值、细胞外容积比例(ECV)和延迟强化(LGE).结果左心形态与功能结果显示,AVM组左心室射血分数(LVEF)及心脏指数(CI)较IIM组减低(P<0.05).心肌组织特征成像结果显示,AVM组的LGE发生率及LGE的百分比均高于IIM组(21/24,87.5%vs 18/29,62.1%,P=0.037;32.87±22.58 vs 19.02±14.78,P=0.032);IIM组的LGE好发于室间隔心肌中层;AVM组的LGE好发于左室游离壁,且易累及心肌外膜.此外,AVM组初始T1值、ECV值以及T2值均较IIM组明显升高(P<0.05).结论利用CMR可以鉴别AVM与IIM心肌受累,IIM的LGE位置一般位于室间隔心肌中层;AVM的LGE位置更多位于左室游离壁心外膜,心肌受累程度较IIM更重.Objective To explore the value of cardiac magnetic resonance(CMR)imaging in the differentiating myocardial involvement in idiopathic inflammatory myopathy(IIM)and acute viral myocarditis(AVM).Methods The clinical and CMR data of 29 IIM and 24 AVM patients proved by clinic were retrospectively reviewed.CMR data,including left heart morphologic and functional parameters and myocardial tissue characterization imaging parameters,such as native T1 value,T2 value,extracellular volume(ECV),and late gadolinium enhancement(LGE)were analyzed.Results Left heart morphologic and functional parameters showed that left ventricular ej ection fraction(LVEF)and cardiac index(CI)in AVM group were lower than those in IIM group(P<0.05).Myocardial tissue characterization imaging parameters showed that the incidence and the percentage of LGE in AVM group were higher than those in IIM group(21/24,87.5%vs 18/29,62.1%,P=0.037;32.87±22.58 vs 19.02±14.78,P=0.032);In IIM group,LGE was predominantly found in the mid-wall of the interventricular septum;while in AVM group,the left ventricular free wall was easy to be involved,especially the subepicardial layer.Besides,the native T1 value,ECV value and T2 value in AVM group were significantly higher than those in IIM group(P<0.05).Conclusion CMR can be used to distinguish myocardial involvement in IIM and AVM.IIM with LGE has a specific tendency to the mid-wall of the interventricular septum;AVM with LGE is usually observed in the left ventricular free wall,especially the subepicardial layer,and the degree of myocardial involvement is more severe than that of IIM.

关 键 词：心脏磁共振 特发性炎性肌病 急性病毒性心肌炎 

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]