心脏磁共振定量组织标志物在急性心肌炎诊断中的临床应用价值

L. Gang, Zeng Mu, Ma Zenglin, L. Jiayi, Fan Zhanming, Liu Dongting, Wen Zhaoying
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Receiver operating characteristics analysis was performed to compare diagnostic performance. Results:\n T2-ratio (1.85±0.21 vs. 1.58±0.15; P = 0.002) and EGEr (3.87±1.62 vs. 2.15±1.36; P =0.024) were significantly higher in myocarditis subjects than in control subjects. Non-ischemic LGE was found in 27/35 (77.1%) of all myocarditis patients. Regional myocardial edema\n was found in 23/35 (65.7%) of all myocarditis patients. Myocardial T1 and T2 relaxation times and ECV were significantly prolonged in the myocarditis group compared with the control group (T1 native relaxation time: 1310±62 vs. 1247±27 ms, T2 native relaxation time: 65.46±8.49\n vs. 55.17±3.59 ms; ECV: 34.47±8.52 vs. 27.68±5.82, P < 0.001, respectively). Areas under the curve of native T1 (0.94) and T2 relaxation times (0.91) were higher compared with those of the other CMR parameters (T2-ratio: 0.73, EGEr: 0.72, LGE: 0.88, LLC: 0.90, ECV:\n 0.79). 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引用次数: 3

摘要

目的:探讨心脏磁共振(CMR)定量组织标志物在急性心肌炎诊断中的价值,并与传统的Lake-Louise标准(LLC)进行比较。方法:选取2014年5月至2016年8月在北京安贞医院诊断为急性心肌炎的患者35例及健康志愿者35例。CMR方案包括使用改进的Look-Locker反转恢复(MOLLI)、细胞外体积分数(ECV)、T2弛豫时间定量评估T1弛豫时间。建立的Lake-Louise标准(LLC)由t2加权信号强度比(T2-ratio)、早期钆增强比(EGEr)和晚期钆增强(LGE)组成。进行受者操作特征分析以比较诊断性能。结果:t2比值(1.85±0.21∶1.58±0.15);P = 0.002)和EGEr(3.87±1.62∶2.15±1.36;P =0.024),心肌炎组明显高于对照组。35例心肌炎患者中有27例(77.1%)存在非缺血性LGE。35例心肌炎患者中有23例(65.7%)出现局部心肌水肿。心肌炎组心肌T1、T2舒张时间和ECV较对照组明显延长(T1自然舒张时间:1310±62比1247±27 ms, T2自然舒张时间:65.46±8.49比55.17±3.59 ms;ECV: 34.47±8.52 vs. 27.68±5.82,P < 0.001)。与其他CMR参数(T2-ratio: 0.73, EGEr: 0.72, LGE: 0.88, LLC: 0.90, ECV: 0.79)相比,原生T1(0.94)和T2弛豫时间(0.91)曲线下面积较大。结合LGE,各原生定位技术的诊断性能均优于LLC (P < 0.01)。与无需造影剂应用的LLC相比,原生参数(T1、T2松弛时间)的组合显著提高了CMR的诊断性能(0.99 vs 0.90;P < 0.05)。结论:CMR定量组织标记物对急性心肌炎有较好的诊断效果,未来有可能取代Lake-Louise标准用于有钆基造影剂禁忌症的患者。
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Cardiac Magnetic Resonance Quantitative Tissue Markers in the Clinical Application Value for the Diagnosis of Acute Myocarditis
Objectives: To determine the value of cardiac magnetic resonance (CMR) quantitative tissue markers in the diagnosis of acute myocarditis, compared with the traditional Lake-Louise criteria (LLC). Methods: Totally 35 cases of patients diagnosed as acute myocarditis in Beijing Anzhen Hospital and 35 healthy volunteers were enrolled in our study, from May 2014 to August 2016. CMR protocol included quantitative assessment of T1 relaxation times using modified Look-Locker inversion recovery (MOLLI), extracellular volume fraction (ECV), T2 relaxation times. Established Lake-Louise criteria (LLC) consisting of T2-weighted signal intensity ratio (T2-ratio), early gadolinium enhancement ratio (EGEr), and late gadolinium enhancement (LGE) were assessed. Receiver operating characteristics analysis was performed to compare diagnostic performance. Results: T2-ratio (1.85±0.21 vs. 1.58±0.15; P = 0.002) and EGEr (3.87±1.62 vs. 2.15±1.36; P =0.024) were significantly higher in myocarditis subjects than in control subjects. Non-ischemic LGE was found in 27/35 (77.1%) of all myocarditis patients. Regional myocardial edema was found in 23/35 (65.7%) of all myocarditis patients. Myocardial T1 and T2 relaxation times and ECV were significantly prolonged in the myocarditis group compared with the control group (T1 native relaxation time: 1310±62 vs. 1247±27 ms, T2 native relaxation time: 65.46±8.49 vs. 55.17±3.59 ms; ECV: 34.47±8.52 vs. 27.68±5.82, P < 0.001, respectively). Areas under the curve of native T1 (0.94) and T2 relaxation times (0.91) were higher compared with those of the other CMR parameters (T2-ratio: 0.73, EGEr: 0.72, LGE: 0.88, LLC: 0.90, ECV: 0.79). Combined with LGE, each native mapping technique outperformed the diagnostic performance of LLC (P < 0.01, respectively). A combination of native parameters (T1, T2 relaxation times) significantly increased the diagnostic performance of CMR compared with LLC without need of contrast media application (0.99 vs. 0.90; P < 0.05). Conclusion: CMR quantitative tissue markers has good diagnostic efficiency for acute myocarditis, it may be potential to replace the Lake-Louise criteria in the future in patients with contraindications for the use of gadolinium-based contrast agents.
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Journal of Medical Imaging and Health Informatics
Journal of Medical Imaging and Health Informatics MATHEMATICAL & COMPUTATIONAL BIOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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期刊介绍: Journal of Medical Imaging and Health Informatics (JMIHI) is a medium to disseminate novel experimental and theoretical research results in the field of biomedicine, biology, clinical, rehabilitation engineering, medical image processing, bio-computing, D2H2, and other health related areas. As an example, the Distributed Diagnosis and Home Healthcare (D2H2) aims to improve the quality of patient care and patient wellness by transforming the delivery of healthcare from a central, hospital-based system to one that is more distributed and home-based. Different medical imaging modalities used for extraction of information from MRI, CT, ultrasound, X-ray, thermal, molecular and fusion of its techniques is the focus of this journal.
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