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目的通过对心肌炎患儿心脏磁共振成像(CMR)检查,探讨CMR评价心肌炎患儿心肌损伤的可行性及临床价值。方法对首都医科大学附属北京安贞医院儿科20例心肌炎患儿行CMR检查,评价心脏功能、心肌组织病理改变性质、部位;分析心脏CMR心肌组织病理改变与20例患儿心电图(ECG)、心肌酶、X线、超声心动图(ECHO)结果的相关性。结果 20例心肌酶、ECG均有不同程度改变、ECHO及胸片显示心脏增大的心肌炎患儿,CMR检查结果提示左心室增大与ECHO一致;心肌损害检测敏感率100%;19例患儿CMRT2加权相时可见心肌组织水肿;1例肌钙蛋白正常,但是CMRT1延迟强化可见心外膜下小片状心肌坏死。结论相比临床诊断指标,CMR能够准确、无创的提供心肌炎患儿心肌损伤性质、程度,有助于临床诊断和判断预后;CMR显示儿童心肌炎心肌损伤部位以心外膜下为最常见。
Objective To investigate the feasibility and clinical value of CMR in assessing myocardium injury in children with myocarditis by cardiac magnetic resonance imaging (CMR) in children with myocarditis. Methods CMR was performed on 20 children with myocarditis in Beijing Anzhen Hospital affiliated to Capital Medical University to evaluate the cardiac function and the pathological changes of myocardium. The pathological changes of cardiac CMR were compared with those of 20 children with electrocardiogram (ECG), myocardium Enzyme, X-ray, echocardiographic (ECHO) results. Results 20 cases of myocardial enzymes, ECG were varying degrees of change, ECHO and chest X-ray showed increased cardiac myocarditis in children, CMR examination showed that left ventricular enlargement consistent with ECHO; myocardial damage detection rate of 100%; 19 cases of children Myocardial tissue edema was observed in CMRT2-weighted phase; in 1 case, troponin was normal, but epicardial platelet-like myocardial necrosis was seen with delayed enhancement of CMRT1. Conclusion Compared with clinical diagnostic criteria, CMR can provide accurate and noninvasive characteristics of myocardial injury in children with myocarditis, which is helpful to clinical diagnosis and prognosis. CMR shows that epicardial myocardium is the most common site of myocardial injury in children.