CAJ | 학술논문

目的探讨心脏磁共振(CMR)心肌灌注和延迟增强扫描对儿童病毒性心肌炎(VMC)的诊断价值.方法选择28例VMC患儿作为VMC组,其中男18例,女10例;年龄5～16岁,平均9.6岁.7例原发性扩张型心肌病患儿作为扩心组,其中男5例,女2例;年龄1.2～10.0岁,平均6.2岁;同时选择13例健康儿童作为健康对照组,其中男8例,女5例;年龄6～12岁,平均8.9岁.所有儿童先抽取外周血检测肌钙蛋白T、肌酸激酶同工酶质量、N端脑钠肽前体,行心电图和经胸超声心动图检查.然后在急性期完成CMR检查,将CMR结果与心肌损伤标志物、心电图、超声心动图结果对比,5例VMC患儿于恢复期复查CMR,并将结果与急性期CMR结果进行对比.结果患儿中年龄最小者为1.2岁,均顺利完成CMR检查,无一例出现对比剂过敏及其他并发症,心率在120次/min以下,平均检查时间为40 min ～1 h.其中重症VMC9例,普通VMC19例.VMC组心腔扩大者7例,局部心肌变薄者12例,室间隔心肌增厚者2例,心肌动度减低者8例,左心室射血分数(LVEF)减低者4例,T2加权像出现高信号者1例,出现心肌延迟强化者17例.CMR延迟增强扫描在VMC组的敏感度明显高于扩心组(60.71％比0,P＜0.01),并且对重症VMC的敏感度明显高于普通VMC(100.00％比42.11％,P＜0.01),特异度均为100％.5例患儿分别于急性期和恢复期行CMR,其中3例患儿恢复期CMR延迟期强化信号消失,2例患儿延迟期强化信号强度较急性期减弱,范围较急性期减小.结论 CMR是儿童VMC安全有效的无创性检查手段.VMC在CMR上表现为心脏扩大,局部心肌变薄、动度减低,LVEF减低,延迟增强扫描时病灶区出现强化信号是其特异性表现,延迟增强扫描对重症VMC敏感度高于对普通VMC的敏感度,并具有较高的特异度.CMR心肌延迟增强扫描可以动态观察心肌炎症的变化,可用于病情随访.
목적 탐토심장자공진(CMR)심기관주화연지증강소묘대인동병독성심기염(VMC)적진단개치.방법 선택28례VMC환인작위VMC조,기중남18례,녀10례;년령5～16세,평균9.6세.7례원발성확장형심기병환인작위확심조,기중남5례,녀2례;년령1.2～10.0세,평균6.2세;동시선택13례건강인동작위건강대조조,기중남8례,녀5례;년령6～12세,평균8.9세.소유인동선추취외주혈검측기개단백T、기산격매동공매질량、N단뇌납태전체,행심전도화경흉초성심동도검사.연후재급성기완성CMR검사,장CMR결과여심기손상표지물、심전도、초성심동도결과대비,5례VMC환인우회복기복사CMR,병장결과여급성기CMR결과진행대비.결과 환인중년령최소자위1.2세,균순리완성CMR검사,무일례출현대비제과민급기타병발증,심솔재120차/min이하,평균검사시간위40 min ～1 h.기중중증VMC9례,보통VMC19례.VMC조심강확대자7례,국부심기변박자12례,실간격심기증후자2례,심기동도감저자8례,좌심실사혈분수(LVEF)감저자4례,T2가권상출현고신호자1례,출현심기연지강화자17례.CMR연지증강소묘재VMC조적민감도명현고우확심조(60.71％비0,P＜0.01),병차대중증VMC적민감도명현고우보통VMC(100.00％비42.11％,P＜0.01),특이도균위100％.5례환인분별우급성기화회복기행CMR,기중3례환인회복기CMR연지기강화신호소실,2례환인연지기강화신호강도교급성기감약,범위교급성기감소.결론 CMR시인동VMC안전유효적무창성검사수단.VMC재CMR상표현위심장확대,국부심기변박、동도감저,LVEF감저,연지증강소묘시병조구출현강화신호시기특이성표현,연지증강소묘대중증VMC민감도고우대보통VMC적민감도,병구유교고적특이도.CMR심기연지증강소묘가이동태관찰심기염증적변화,가용우병정수방.
Objective To determine the diagnostic value of myocardial perfusion imaging and delayed enhancement scan examination by cardiac magnetic resonance(CMR) in children with viral myocarditis(VMC).Methods Twenty-eight children who had been diagnosed as VMC(18 male and 10 female;age range 5-16 years,and mean age 9.6 years) were chosen as the VMC group,7 children with primary dilated cardiomyopathy(5 male and 2 female; age range 1.2-10.0 years,and mean age 6.2 years) were chosen as the group of DCM,and another 13 healthy children(8 male and 5 female;age range 6-12 years,and mean age 8.9 years) were chosen as the control group.Cardiac injury markers[cardiac troponin T (cTnT),creatine kinase-MB-mas (CK-MB-mas) and pro-brain natriuretic peptide (pro-BNP)],electrocardiogram,and transthoracic echocardiography were performed on all of the children before CMR imaging.All the children underwent CMR imaging,and the results of CMR was compared with cardiac injury markers,electrocardiograms and echocardiography.Five children with VMC re-examined CMR in recovery phase.Results Among the 28 VMC cases,9 children were diagnosed as severe VMC and the rest 19 children were diagnosed as common VMC.The youngest children with VMC was 1.2 years old,and all the children were performed CMR imaging successfully and safely,and no adverse reaction to the contrast agent and other complications occurred.Heart rate of all the children were under 120 beats per minute,and the mean examination time was 40 min to an hour.Seven cases with dilated heart,12 cases with regional thinning myocardium,2 cases with thickening interventricular septum,8 cases with reduced myocardial mobility,4 cases with reduced left ventricular ejection fraction,1 case with high signal in T2-weighted image,17 cases showed delayed-enhancement,and the sensitivity of CMR delayed enhancement scanning in children received VMC was significantly higher than that in children with dilated cardiomyopathy(60.71％ vs 0,P ＜0.01),and the sensitivity in severe VMC sensitivity was significantly higher than that of ordinary VMC(100.00％ vs 42.11％,P ＜0.01).The specificity was 100％ in VMC group.Five children received VMC re-examination CMR after their treatments,and 3 cases' delayed-enhancement signals disappeared while the other 2 cases' became weaker than before.Conclusions CMR is a safely and effectively noninvasive means to diagnose VMC.VMC performed expanded heart,regional thinning myocardium,reduced mobility,reduced left ventricular ejection fraction,high signal in T2 weighted imaging and delayed enhancement signal in CMR.The specificity of CMR delayed enhancement examination in severe VMC is higher than the sensitivity in ordinary VMC.CMR delayed enhancement examination could dynamically observe the changes in myocardial inflammation,and it can be used in the follow-up of VMC.