BACKGROUND Multiple studies in adult patients suggest that tissue mapping performed by cardiovascular magnetic resonance (CMR) has excellent diagnostic accuracy in acute myocarditis, however, these techniques have not been studied in depth in children. METHODS CMR data on 23 consecutive pediatric patients from 2014 to 2017 with a clinical diagnosis of acute myocarditis were retrospectively analyzed and compared to 39 healthy controls. The CMR protocol included native T1, T2, and extracellular volume fraction (ECV) in addition to standard Lake Louise Criteria (LLC) parameters on a 1.5 T scanner. RESULTS Mean global values for novel mapping parameters were significantly elevated in patients with clinically suspected acute myocarditis compared to controls, with native T1 1098 ± 77 vs 990 ± 34 ms, T2 52.8 ± 4.6 ms vs 46.7 ± 2.6 ms, and ECV 29.8 ± 5.1% vs 23.3 ± 2.6% (all p-values < 0.001). Ideal cutoff values were generated using corresponding ROC curves and were for global T1 1015 ms (AUC 0.936, sensitivity 91%, specificity 86%), for global T2 48.5 ms (AUC 0.908, sensitivity 91%, specificity 74%); and for ECV 25.9% (AUC 0.918, sensitivity 86%, specificity 89%). While the diagnostic yield of the LLC was 57% (13/23) in our patient cohort, 70% (7/10) of patients missed by the LLC demonstrated abnormalities across all three global mapping parameters (native T1, T2, and ECV) and another 20% (2/10) of patients demonstrated at least one abnormal mapping value. CONCLUSIONS Similar to findings in adults, pediatric patients with acute myocarditis demonstrate abnormal CMR tissue mapping values compared to controls. Furthermore, we found CMR parametric mapping techniques measurably increased CMR diagnostic yield when compared with conventional LLC alone, providing additional sensitivity and specificity compared to historical references. Routine integration of these techniques into imaging protocols may aid diagnosis in children.

中文翻译：

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心血管磁共振天然 T1 和 T2 映射对急性心肌炎儿科患者的诊断性能。


背景对成年患者的多项研究表明，心血管磁共振（CMR）进行的组织标测对急性心肌炎具有极好的诊断准确性，然而，这些技术尚未在儿童中进行深入研究。方法 回顾性分析 2014 年至 2017 年连续 23 名临床诊断为急性心肌炎的儿科患者的 CMR 数据，并与 39 名健康对照者进行比较。除了 1.5 T 扫描仪上的标准路易斯湖标准 (LLC) 参数外，CMR 协议还包括天然 T1、T2 和细胞外体积分数 (ECV)。结果 与对照组相比，临床疑似急性心肌炎患者的新标测参数的平均全局值显着升高，自然 T1 1098 ± 77 vs 990 ± 34 ms，T2 52.8 ± 4.6 ms vs 46.7 ± 2.6 ms，ECV 29.8 ± 5.1 % 与 23.3 ± 2.6%（所有 p 值 < 0.001）。使用相应的 ROC 曲线生成理想的截止值，全局 T1 1015 ms（AUC 0.936，敏感性 91%，特异性 86%），全局 T2 48.5 ms（AUC 0.908，敏感性 91%，特异性 74%）； ECV 为 25.9%（AUC 0.918，敏感性 86%，特异性 89%）。虽然 LLC 在我们的患者队列中的诊断率为 57% (13/23)，但 LLC 漏诊的患者中有 70% (7/10) 表现出所有三个全局映射参数（原始 T1、T2 和 ECV）的异常另外 20% (2/10) 的患者表现出至少一个异常映射值。结论 与成人的研究结果类似，与对照组相比，急性心肌炎儿童患者的 CMR 组织图谱值异常。 此外，我们发现与单独使用传统 LLC 相比，CMR 参数映射技术可显着提高 CMR 诊断率，与历史参考相比，提供了额外的灵敏度和特异性。将这些技术常规整合到成像方案中可能有助于儿童的诊断。