Diagnostic Performance of CMR Imaging Compared With EMB in Patients With Suspected Myocarditis
Diagnostic Performance of CMR Imaging Compared With EMB in Patients With Suspected Myocarditis
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DOI：
10.1016/j.jcmg.2011.11.022
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发表时间：
2012-05-01
影响因子：
14
通讯作者：
Thiele, Holger
中科院分区：
文献类型：
--
作者：
Lurz, Philipp;Eitel, Ingo;Thiele, Holger
本研究的目的是评估心脏磁共振（CMR）与心肌内膜活检在疑似急性心肌炎（AMC）和慢性心肌炎（CMC）患者中的诊断性能。然而，CMR与临床数据的比较和预选的患者人群的使用是重要的限制，大多数这些reports.METHODS一百三十二个连续可疑AMC患者（定义症状14天，n = 62）。患者接受了左心室肌内膜活检和CMR的心导管插入术，包括用于评估水肿的T-2加权成像，用于评估充血的造影剂给药前后的T-1加权成像，以及晚期钆增强的评估。CMR结果被认为是与心肌炎的诊断一致，如果2的3 CMR技术是阳性的。结果在总人口中，心肌炎是最常见的诊断对心肌内膜活检分析（62.9%）。在总患者人群中30.3%（40/132）的患者中检测到病毒基因组，AMC患者的检出率显著高于CMC患者（40.0% vs. 19.4%; p = 0.013）。对于疑似AMC或CMC的患者的整个队列，CMR的诊断灵敏度、特异性和准确性分别为76%、54%和68%。在疑似AMC患者中观察到最佳诊断性能（敏感性，81%;特异性，71%;准确性，79%）。相比之下，CMR在疑似CMC的诊断性能被认为是不令人满意的（敏感性，63%;特异性，40%;和准确性，52%）。相反，CMR在疑似CMC患者中的诊断性能可能不足以指导临床管理。（J Am科尔心脏病学杂志2012;5：513-24）（C）美国心脏病学会基金会2012年
OBJECTIVES The goal of this study was to assess the diagnostic performance of cardiac magnetic resonance (CMR) compared with endomyocardial biopsy in patients with suspected acute myocarditis (AMC) and chronic myocarditis (CMC).BACKGROUND Several studies have reported an encouraging diagnostic performance of CMR in myocarditis. However, the comparison of CMR with clinical data only and the use of preselected patient populations are important limitations of the majority of these reports.METHODS One hundred thirty-two consecutive patients with suspected AMC (defined by symptoms 14 days; n = 62) were included. Patients underwent cardiac catheterization with left ventricular endomyocardial biopsy and CMR, including T-2-weighted imaging for assessment of edema, T-1-weighted imaging before and after contrast administration for evaluation of hyperemia, and assessment of late gadolinium enhancement. CMR results were considered to be consistent with the diagnosis of myocarditis if 2 of 3 CMR techniques were positive.RESULTS Within the total population, myocarditis was the most common diagnosis on endomyocardial biopsy analysis (62.9%). Viral genomes were detected in 30.3% (40 of 132) of patients within the total patient population and significantly more often in patients with AMC than CMC (40.0% vs. 19.4%; p = 0.013). For the overall cohort of patients with either suspected AMC or CMC, the diagnostic sensitivity, specificity, and accuracy of CMR were 76%, 54%, and 68%, respectively. The best diagnostic performance was observed in patients with suspected AMC (sensitivity, 81%; specificity, 71%; and accuracy, 79%). In contrast, diagnostic performance of CMR in suspected CMC was found to be unsatisfactory (sensitivity, 63%; specificity, 40%; and accuracy, 52%).CONCLUSIONS The results of this study underline the usefulness of CMR in patients with suspected AMC. In contrast, the diagnostic performance of CMR in patients with suspected CMC might not be sufficient to guide clinical management. (J Am Coll Cardiol Img 2012;5:513-24) (C) 2012 by the American College of Cardiology Foundation