Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis -: Comparison of different approaches
Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis -: Comparison of different approaches
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DOI：
10.1016/j.jacc.2004.11.069
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发表时间：
2005-06-07
影响因子：
24
通讯作者：
Schulz-Menger, J
中科院分区：
文献类型：
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作者：
Abdel-Aty, H;Boyé, P;Schulz-Menger, J
本研究的目的是确定钆增强和T2加权心血管磁共振（CMR）在疑似急性心肌炎的诊断性能。背景急性心肌炎是很难诊断的，CMR提供了各种手段来可视化心肌炎症变化。需要一种具有明确诊断标准的CMR方法。方法我们调查了25名疑似急性心肌炎患者（18名男性，44 ± 17岁）和23名健康对照（13名男性，29 ± 10岁）。心血管磁共振研究包括以下序列：1）T2加权三重反转恢复; 2）钆注射前和注射后4分钟内的T1加权自旋回波; 3）钆注射后10分钟的反转恢复-梯度回波。结果：心肌梗死组T2信号强度（SI）、心肌整体相对强化（gRE）、心肌延迟强化（LGE）面积均高于对照组，心肌梗死组T2信号强度（SI）、心肌整体相对强化（gRE）均高于对照组（T2：2.3 +/- 0.4对比1.7 +/- 0.4; p < 0.0001，gRE：6.8 +/- 4.0对比3.7 +/- 2.3; p < 0.001）。T2（临界值为1.9）的灵敏度、特异性和诊断准确性分别为84%、74%和79%; gRE（临界值为4.0）分别为80%、68%和74.5%; LGE分别为44%、100%和71%。最好的诊断性能时，“任何两个”的三个序列是积极的，在同一个病人产生76%的敏感性，95.5%的特异性，和85%的诊断accuracy.CONCLUSIONS一个组合CMR的方法，使用T2加权成像，早期和晚期钆增强，提供了很高的诊断准确性，是一个有用的工具，在诊断和评估疑似急性心肌炎的患者。(c)2005年美国心脏病学会基金会
OBJECTIVES The aim of this research was to identify the diagnostic performance of gadolinium-enhanced and T2-weighted cardiovascular magnetic resonance (CMR) in suspected acute myocarditis.BACKGROUND Acute myocarditis is difficult to diagnose; CMR provides various means to visualize myocardial inflammatory changes. A CMR approach with clear-cut diagnostic criteria would be desirable.METHODS We investigated 25 patients with suspected acute myocarditis (18 males, 44 +/- 17 years) and 23 healthy controls (13 males, 29 10 years). Cardiovascular magnetic resonance studies included the following sequences: 1) T2-weighted triple inversion recovery; 2) T1-weighted spin echo before and over 4 min after gadolinium injection; and 3) inversion recovery-gradient echo 10 min after gadolinium injection. Qualitative and quantitative image analysis was performed for: 1) focal and global T2 signal intensity (SI); 2) myocardial global relative enhancement (gRE); and 3) areas of late gadolinium enhancement (LGE).RESULTS Both global T2 SI and gRE were higher in patients than in controls (T2: 2.3 +/- 0.4 vs. 1.7 +/- 0.4; p < 0.0001, gRE: 6.8 +/- 4.0 vs. 3.7 +/- 2.3; p < 0.001). The sensitivity, specificity, and diagnostic accuracy for T2 (cutoff value of 1.9) were 84%, 74%, and 79%, respectively; gRE: (cutoff value of 4.0) 80%, 68%, and 74.5% respectively; LGE: 44%, 100%, and 71%, respectively. The best diagnostic performance was obtained when "any-two" of the three sequences were positive in the same patient yielding a 76% sensitivity, 95.5% specificity, and 85% diagnostic accuracy.CONCLUSIONS A combined CMR approach using T2-weighted imaging, early and late gadohnium enhancement, provides a high diagnostic accuracy and is a useful tool in the diagnosis and assessment of patients with suspected acute myocarditis.(c) 2005 by the American College of Cardiology Foundation