Purpose

The aim of this study was to investigate the diagnostic value of myocardial deformation analysis based on the 17-segment heart model using non-contrast enhanced (CE) 2D tissue feature tracking (2D-FT) technique.

Material and methods

Seventy patients with suspected myocarditis underwent a cardiovascular magnetic resonance (CMR) examination at 1.5 Tesla. A contrast-agent-free part of this CMR protocol was additionally performed in forty healthy volunteers (HV). Besides standard CMR data sets, 2D-FT derived segmental and global longitudinal, radial, and circumferential deformation parameters were analyzed. The 2D-FT results were compared to the combined findings from CMR imaging and endomyocardial biopsy (EMB).

Results

Patients were assigned to three groups depending on their ejection fraction (EF) (<40%, 40–55%, ≥55%). Compared to HV, impaired EF (<55%) was significantly correlated to reduced segmental and global strain and strain rate values. The circumferential deformation analysis was more sensitive to myocardial changes than longitudinal and radial analysis. The segmental strain/strain rate had an accuracy of 84.3%/70.0% for the diagnosis of an acute myocarditis, stated by EMB and CMR in 42 of 70 patients. In patients with preserved EF, acute myocarditis could be ruled out using only segmental strain analysis with a negative predictive value of 87.5%.

Conclusion

In patients with suspected myocarditis, the deformation analysis based on the 17-segment heart model provides valuable information about functional myocardial inhomogeneity. This quantitative approach could be used in addition to the clinical standard CMR protocol and represents a promising tool in the framework of a prospective automatized multiparametric CMR imaging analysis.

中文翻译：

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基于二维特征跟踪磁共振成像的17段心脏模型的无对比度增强诊断急性心肌炎

目的

这项研究的目的是调查使用17段心脏模型，使用非对比增强（CE）二维组织特征跟踪（2D-FT）技术的心肌变形分析的诊断价值。

材料与方法

70名疑似心肌炎的患者在1.5特斯拉接受了心血管磁共振（CMR）检查。此CMR方案的无造影剂部分还另外在40名健康志愿者（HV）中进行。除了标准的CMR数据集外，还分析了2D-FT得出的分段和整体纵向，径向和圆周变形参数。将2D-FT结果与CMR成像和心内膜活检（EMB）的综合结果进行比较。

结果

根据其射血分数（EF）将患者分为三组（<40％，40-55％，≥55％）。与HV相比，EF受损（<55％）与节段和整体应变及应变率值降低显着相关。与纵向和径向分析相比，周向变形分析对心肌变化更敏感。EMB和CMR在70例患者中有42例表示，节段应变/应变率对于诊断急性心肌炎的准确性为84.3％/ 70.0％。对于EF保留的患者，仅使用分段应变分析就可以排除急性心肌炎，其阴性预测值为87.5％。

结论

在疑似心肌炎的患者中，基于17段心脏模型的变形分析可提供有关功能性心肌不均匀性的有价值的信息。除了临床标准CMR协议外，还可以使用这种定量方法，并且在前瞻性自动化多参数CMR成像分析框架中代表了一种有前途的工具。