儿童急性心肌炎磁共振左心室心肌应变特征及诊断效能研究  

Comparison of left ventricular strain characteristics and diagnostic efficiency of magnetic resonance imaging in pediatric with acute myocarditis

作　　者：赵奇光 周杰[1] 徐磊[1] ZHAO Qiguang;ZHOU Jie;XU Lei(Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所医学影像科,100029 [2]首都医科大学医学影像学系

出　　处：《心肺血管病杂志》2025年第3期293-300,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家重点研发计划战略性科技创新合作项目(2022YFE0209800)。

摘　　要：目的:探讨急性心肌炎(acute myocarditis,AM)患儿心脏磁共振左心室心肌应变参数特征差异及其诊断效能。方法:回顾性收集2018年1月至2024年8月在北京安贞医院儿科根据欧洲心脏病学会与中华医学会的诊断标准,所有患儿均被诊断为AM儿童80例作为观察组,同期选择40例年龄、性别匹配的健康者作为健康儿童组。将80例AM儿童根据磁共振有无阳性表现是否符合路易斯湖标准,分为满足路易斯湖标准的磁共振阳性组和不满足路易斯湖标准的磁共振阴性组,所有儿童均接受电影序列的心脏MRI检查,包括标准切面的两腔、三腔、四腔及短轴位。采用磁共振后处理站CVI42计算不同组受试者的心脏功能,并应用心脏磁共振组织追踪(cardiac magnetic resonance tissue tracking,CMR-TT)技术测量左心室心肌应变参数值(左心室整体周向应变、径向应变及纵向应变)并进行组间比较。使用受试者工作特征(ROC)曲线评估左心室应变参数诊断儿童AM的效能。结果:研究共纳入AM儿童80例,平均年龄(6.9±1.6)岁,其中男孩40例(50%),62例患者符合路易斯湖诊断标准(lake louise consensus criteria,LLC)磁共振阳性表现。健康组儿童40例,其中男孩20例,女孩20例,平均年龄(7.3±1.9)岁,两组间性别、年龄、体质量、身高差异均无统计学意义(P>0.05),儿童AM组的左心室心肌整体纵向应变(global longitudinal strain,GLS)、周向应变(global circumferential strain,GCS)、径向应变(global radial strain,GRS)值均低于健康组(P<0.05)。左心室周向应变和径向应变预测AM组的敏感度分别为78.8%和82.5%,特异度分别为52.5%和45%。磁共振阴性的心肌炎患者心肌整体径向应变、周向应变值仍低于健康组(P<0.05)。左心室周向应变和径向应变在磁共振阴性人群中预测AM组的敏感度分别为72.2%和77.5%,特异度分别为77.8%和45%。结论:CMR-TT技术能够通过左心室心肌应变参数定量评估儿童AObjective:To explore differences in left ventricular myocardial strain parameters and their diagnostic efficacy in pediatric acute myocarditis compared with healthy children.Methods:From January 2018 to August 2024,80 children were diagnosed with acute myocarditis(AM)according to the diagnostic criteria formulated by the Chinese Medical Association and the European Society of Cardiology as the observation group,and 40 age-and gender-matched healthy children were selected as the healthy children group in the same period.80 children with acute myocarditis were divided into MR positive and MR negative groups based on positive MR findings,and all subjects underwent sequential cardiac MRI including standard two,three,four,and short axial positions.The cardiac function of the two groups was calculated by the MR postprocessing station CVI 42,and the CMR-TT technique was used to measure the values of various myocardial strain parameters(radial strain,circumferential strain and longitudinal strain)in the left ventricular muscle and compare between groups.The receiver operating characteristic curve(ROC)was used to evaluate the efficacy of left ventricular strain parameters to diagnose acute myocarditis in children.Results:A total of 80 children with acute myocarditis with a mean age of(6.9±1.6)years,40 boys(50%)and 62 patients with positive MR findings,T2WI or LGE.40 patients in the normal group,of these,20 cases were boys,20 girls,The mean age was(7.3±1.9)years,there was no significant difference in age,sex,height,and weight composition between the two groups(P>0.05).The global longitudinal strain(GLS),global circumferential strain(GCS),and global radial strain(GRS)values in the pediatric acute myocarditis group were lower than the healthy group(P<0.05).The sensitivity of the left ventricular peripheral strain and radial strain groups for predicting acute myocarditis was 78.8%and 82.5%sensitivity,respectively,and 52.5%and 45%specificity,respectively.The GRS and GCS strain with negative myocarditis remained lower than th

关 键 词：心肌炎 心脏磁共振组织追踪技术 心肌应变 左心室 

分 类 号：R54[医药卫生—心血管疾病]