多参数心脏磁共振在低龄儿童急性心肌炎中的诊断和短期随访价值  

Diagnostic and short-term follow-up value of multi-parameter cardiac magnetic resonance in young children with acute myocarditis

作　　者：冯占起 尚红磊 廖俊杰 殷星[1] 沈艳勇 鲁钰 李思柯 张晓雪 王长浩 赵鑫[1] FENG Zhanqi;SHANG Honglei;LIAO Junjie;YIN Xing;SHEN Yanyong;LU Yu;LI Sike;ZHANG Xiaoxue;WANG Changhao;ZHAO Xin(Department of Medical Imaging,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院医学影像科,郑州450052

出　　处：《磁共振成像》2024年第5期126-133,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20190381)。

摘　　要：目的探讨多参数心脏磁共振(cardiac magnetic resonance,CMR)在低龄儿童急性心肌炎诊断和短期随访中的应用价值。材料与方法前瞻性分析2022年1月至2024年2月就诊于我院的60例8岁以下的急性心肌炎患儿和30例对照组儿童。收集所有受试者的临床资料和CMR数据[包括左心室心肌的初始T1值、心肌细胞外容积百分数(extracellular volume fraction,ECV)、T2值、T2信号比值、晚期钆增强(late gadolinium enhancement,LGE)情况]。使用受试者工作特征(receiver operating characteristic,ROC)曲线评价单一和联合参数的诊断效能,并计算曲线下面积(area under the curve,AUC)、敏感度、特异度和准确度。采用配对检验比较低龄急性心肌炎患儿初诊和随访时的CMR数据。结果急性心肌炎组的初始T1值、ECV值、T2值、T2信号比值和LGE阳性病例数均显著高于对照组(P均<0.001)。初始T1值、ECV值、T2值、T2信号比值的最佳截断值分别为1232.50 ms、30.50%、53.50 ms、1.75。初始T1值、T2值、T2信号比值的AUC(分别为0.917、0.889、0.839)均高于其他单一参数,但三者之间无显著差异(P均>0.05),其中初始T1值的敏感度和准确度最高,分别为81.7%和83.3%。2018版路易斯湖标准(Lake Louise Criteria,LLC)、排除ECV的2018LLC、初始T1值联合T2值的AUC(分别为0.933、0.917、0.892)均高于其他联合参数,但三者之间无显著差异(P均>0.05),其中2018LLC的敏感度和准确度最高,分别为90.0%和92.2%。与初诊时相比,短期随访时初始T1值、ECV值、T2值、T2信号比值、LGE累及心肌节段数和符合2018LLC的病例数总体上均降低(P均<0.05)。结论多参数CMR可作为诊断低龄儿童急性心肌炎的有效方法,在短期随访时能够监测患儿治疗后的病情变化。Objective:To explore the value of multi-parameter cardiac magnetic resonance(CMR)in the diagnosis and short-term follow-up of acute myocarditis in young children.Materials and Methods:A total of 60 children with acute myocarditis under eight years old and 30 children in the control group who attended our hospital from January 2022 to February 2024 were prospectively analyzed.Clinical information and CMR data[including native T1 value,extracellular volume fraction(ECV),T2 value,T2 signal ratio,and late gadolinium enhancement(LGE)of the left ventricle myocardium]of all subjects were collected.The diagnostic efficacy of single and combined parameters was evaluated using the receiver operating characteristic(ROC)curve,and the area under the curve(AUC),sensitivity,specificity,and accuracy were calculated.The paired test was used to compare the CMR data of young children with acute myocarditis at initial diagnosis and follow-up.Results:The native T1 value,ECV value,T2 value,T2 signal ratio,and LGE-positive cases were significantly higher in the acute myocarditis group than in the control group(all P<0.001).The optimal cut-off values of the native T1 value,ECV value,T2 value,and T2 signal ratio were 1232.50 ms,30.50%,53.50 ms,and 1.75,respectively.The AUCs of the native T1 value,T2 value,and T2 signal ratio(0.917,0.889 and 0.839,respectively)were higher than those of other single parameters,but there was no significant difference between the three parameters(all P>0.05),with the native T1 value having the highest sensitivity and accuracy of 81.7%and 83.3%,respectively.The AUCs of the 2018 Lake Louise Criteria(LLC),the 2018LLC excluding ECV,and the native T1 value combined with the T2 value(0.933,0.917 and 0.892,respectively)were higher than other combined parameters,but there was no significant difference between the three parameters(all P>0.05),with 2018LLC having the highest sensitivity and accuracy of 90.0%and 92.2%,respectively.Compared with the initial diagnosis,the native T1 value,ECV value,T2 value,T2 signal rati

关 键 词：急性心肌炎 儿童 诊断 随访 心脏磁共振 路易斯湖标准 磁共振成像 

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