| ObjectiveTo discuss the clinical application values of MRI for diagnosing pediatric myocarditis and to analysis whether there were correlations between the performances of MRI and other clinical diagnostic methods.Materials and MethodsThe first part, thirty two patients with myocarditis (mean age±standard deviation,9.56±3.32years; girl:40.60%, boy:59.40%) and twenty two control subjects (mean age±standard deviation,9.07+3.94 years; girl:45.50%,boy:54.50%) were enrolled. The results of MRI included cardiac function?T2 weight imaging(T2WI)?early gadolinium enhancement(EGE)? late gadolinium enhancement (LGE), and other clinical diagnostic results were collected. The sensitivity, specificity, accuracy of each sequence were calculated. Receiver operating characteristic analysis was performed to evaluate MRI diagnostic performance.The second part, twenty five patients with myocarditis (mean age+standard deviation,9.56±3.04years; girl:44%, boy:56%) and twenty two control subjects (mean age+standard deviation,9.07±3.94years; girl:45.50%, boy:54.50%) were enrolled. Cardiac MR imaging approaches included cardiac function analysis, T2WI, EGE and LGE. Other clinical diagnostic methods mainly included symptoms and signs, laboratory examination, electrocardiogram, echocardiography. Spearman correlation analysis was performed to investigate the relations between the performances of MRI and other clinical diagnostic methods. Besides, logistic regression was analyzed to discus s the clinical values of abnormal cardiac function and signal intensity for diagno sing pediatric myocarditis.ResultsThe first part, according to the"Lake Loui se criteria consensus", The sensitivity,specificity and accuracy of T2WI SI(signal intensity)ratio. EGE SI ratio.LGE were 78.13%.40.91%.62.96%:21.88%.95.45%. 51.85%? 40.63%.95.45%.62.96%respectively.The be st diagno stic performance was obtained when"any-two"of the three sequences were po sitive in the same patients yielding a 50%sensitivity,90.91%specificity, and 66.67%diagno stic accuracy which is the best of all with the highest Youden index(0.41).Areas under the curve and 95%CI of T2WI SI ratio. EGE SI ratio. LGE and the combined method were(0.66,0.52-0.79? p =0.03).(0.62,0.47-0.75?p=0.14).(0.51,0.37-0.65?p=0.86).(0.64, 0.5-0.77?p=0.01),but without significant statistical difference(p>0.05) among these method s.Besides,the cutoff values of T2WI and EGE were 2.65 and 2.98 with the(40.63%.46.88%)sen sitivity and(90.91%.72.73%) specificity.The second part,There were significant negative correlations between cardiac function indexes(LVSVI.LVCI.LVEF and RVEF)and NT—proBNP, p values were 0.03,0.01,0.00 and 0.01 respectively.RVESVI had po sitively correlation with NT-proB NP(p=0.03).T2WI SI ratio(2.96±1.13,2.13±0.48? p=0.00)and LGE display rate(48%,4.505?p=0.00)in myocarditis group was higher than control group.T2WI SI ratio was po sitively correlated with cTnI(p=0.00).NT-proBNP(p=0.00)and CRP(p=0.04)respectively.By logistic analysis, we found that the values of increased T2WI SI ratio (0.32,0.11-0.92;p=0.03) and decreased LVEF (1.10,1.01-1.19;p=0.03) were independent risk factors of pediatric myocarditis.ConclusionLake Louise criteria consensus will improve the diagnostic accuracy of pediatric myocarditis. The diagnostic indexes of MRI (cardiac function indexes?T2WI SI ratio?EGE SI ration? LGE and the combined method) can provide valuable information. The methods of combining MRI and clinical diagnostic indexes to evaluate pediatric myocarditis should be further studied. T2WI SI ratio was correlated with laboratory indexes. The value of increased T2WI SI ratio and decreased LVEF were independent risk factors of pediatric myocarditis. |
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