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多模态心脏磁共振成像在急性病毒性心肌炎中的临床价值

Clinical value of multimodal cardiac magnetic resonance imaging in acute viral myocarditis

    摘要
  • 摘要:
      目的  探讨多模态心脏磁共振成像(CMR)在急性病毒性心肌炎(AVM)中的临床价值。
      方法  选择60例AVM患者为观察组，另选取40例健康志愿者为对照组。2组受检者均接受多模态CMR检查，并检测白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。采用受试者工作特征(ROC)曲线分析多模态CMR参数在AVM诊断中的应用价值，并采用Pearson相关性分析对多模态CMR参数与IL-6、TNF-α的关系进行分析。
      结果  观察组左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)、心肌质量(MM)、平均T1值、平均T2值、磁共振延迟强化成像(LGE)体积、LGE占左心室质量百分比、IL-6、TNF-α水平均高于对照组，达峰时间长于对照组，而射血分数(EF)、心输出量(CO)、心肌灌注曲线下面积比、相对峰值信号强度均低于对照组，差异有统计学意义(P < 0.05)。Pearson相关分析结果显示，LVEDV、LVESV、MM、达峰时间、平均T1值、平均T2值、LGE体积、LGE占左心室质量百分比均与IL-6、TNF-α水平呈正相关，而EF、CO、心肌灌注曲线下面积比、相对峰值信号强度均与IL-6、TNF-α水平呈负相关(P < 0.05)。ROC曲线显示，EF、LVEDV、LVESV、CO、MM、心肌灌注曲线下面积比、相对峰值信号强度、达峰时间、平均T1值、平均T2值、LGE体积、LGE占左心室质量百分比对AVM具有一定的诊断价值(AUC=0.747、0.740、0.823、0.750、0.743、0.815、0.796、0.728、0.851、0.840、0.750、0.752，P < 0.01)，且联合诊断价值较高(AUC=0.943，P < 0.01)。
      结论  多模态CMR可快速、准确地诊断出AVM。

     

    Abstract:
      Objective  To explore the clinical value of multimodal cardiac magnetic resonance imaging (CMR) in acute viral myocarditis (AVM).
      Methods  A total of 60 patients with AVM were selected as observation group, and 40 healthy volunteers were selected as control group. Both groups underwent multimodal CMR examinations, and the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were detected. Receiver operating characteristic (ROC) curve was used to analyze the application value of multimodal CMR parameters in AVM diagnosis, and Pearson correlation was used to analyze the relationship between multimodal CMR parameters and levels of IL-6 and TNF-α.
      Results  The left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), myocardial mass (MM), average T1 value, average T2 value, late gadolinium enhancement (LGE) volume, percentage of LGE to left ventricular mass, levels of IL-6 and TNF-α in the observation group were significantly higher than those in the healthy controls, peak time was longer than that in the control group, while ejection fraction (EF), cardiac output (CO), the area ratio under the myocardial perfusion curve and the relative peak signal intensity were significantly lower than those of the healthy controls (P < 0.05). Pearson correlation analysis
      results  showed that LVEDV, LVESV, MM, peak time, average T1 value, average T2 value, LGE volume, percentage of LGE to left ventricular mass were positively correlated with IL-6, TNF-α levels, while EF, CO, the area under the curve of myocardial perfusion and the relative peak signal intensity were negatively correlated with IL-6 and TNF-α levels (P < 0.05). ROC curve showed that EF, LVEDV, LVESV, CO, MM, the area under the curve of myocardial perfusion and the relative peak signal intensity, peak time, average T1 value, average T2 value, LGE volume, percentage of LGE to left ventricular mass had certain value in diagnosing AVM (AUC=0.747, 0.740, 0.823, 0.750, 0.743, 0.815, 0.796, 0.728, 0.851, 0.840, 0.750, 0.752, P < 0.01), and combined diagnostic value was higher(AUC=0.943, P < 0.01).
      Conclusion  Multimodal CMR can quickly and accurately diagnose AVM.

     

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