rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2014-0-5-54-59rentrad-50Research ArticleСЛУЧАЙ ИЗ ПРАКТИКИCLINICAL NOTEМАГНИТНО-РЕЗОНАНСНАЯ ТОМОГРАФИЯ СЕРДЦА В ДИАГНОСТИКЕ ОСТРОГО МИОКАРДИТА: КЛИНИЧЕСКИЙ СЛУЧАЙ И ОБЗОР ЛИТЕРАТУРЫCARDIAC MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF ACUTE MYOCARDITIS: A CLINICAL CASE AND A REVIEW OF LITERATUREЛаринаО. М.LarinaO. M.

к. м. н., рентгенолог

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, Radiologist

Ivan’kovskoe shosse, 3, Moscow, 125367

МершинаЕ. А.MershinaE. A.

к. м. н., заведующая отделением томографии

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, Head of Department of Tomography

Ivan’kovskoe shosse, 3, Moscow, 125367

elena_mershina@mail.ruСиницынВ. Е.SinitsynV. E.

д. м. н., профессор, директор Центра лучевой диагностики ЛРЦ

Иваньковское шоссе, 3, Москва, 125367

MD, PhD, DSc, Professor, Director 

Ivan’kovskoe shosse, 3, Moscow, 125367

АндреевД. А.AndreevD. A.

к. м. н., кардиолог 

ул. Живописная, 46, Москва, 123182

MD, PhD, Cardiologist 

ul. Zhivopisnaya, 46, Moscow, 123182

ФГБУ «Лечебно-реабилитационный центр» Министерства здравоохранения РФРоссияFederal Center of Treatment and Rehabilitation, Ministry of Health of the RFRussian FederationФГБУ ГНЦ «Федеральный медицинский биофизический центр им. А.И. Бурназяна» ФМБА РоссииРоссияA.I. Burnazyan Federal Medical Biophysical Center, Federal Medical-and-Biological Agency of RussiaRussian Federation201428022016055459Copyright © Ларина О.М., Мершина Е.А., Синицын В.Е., Андреев Д.А., 20162016Ларина О.М., Мершина Е.А., Синицын В.Е., Андреев Д.А.Larina O.M., Mershina E.A., Sinitsyn V.E., Andreev D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/50

Клинические проявления миокардита крайне вариабельны, и часто он может манифестировать как острый инфаркт миокарда. Диагноз острого миокардита нередко бывает эмпирическим, обосновывается клинической картиной заболевания, изменениями на электрокардиограмме, повышением уровня ферментов, отсутствием каких-либо данных о коронарной болезни сердца. До недавнего времени наиболее точным методом диагностики миокардита считалась эндомиокардиальная биопсия. Однако она имеет низкую чувствительность и сопряжена с высоким риском осложнений.

В данной статье представлен клинический случай пациента с болями в сердце, возникшими после перенесенного острого респираторно-вирусного заболевания, наличием элевации сегмента ST и повышением уровня кардиоспецифических ферментов. Диагноз миокардита был подтвержден с помощью магнитно-резонансной томографии сердца с контрастированием. 

The clinical manifestations of myocarditis are extremely variable and it may commonly manifest as acute myocardial infarction. The diagnosis of acute myocarditis is frequently empiric and substantiated by the clinical picture of the disease, ECG changes, elevated enzyme levels, and the lack of any data on coronary heart disease. Until recently, endomyocardial biopsy has been considered to be the most accurate diagnostic method. However, endomyocardial biopsy has a low sensitivity and is associated with the high risk of complications.

This paper describes a clinical case of a patient with cardialgias occurring after acute respiratory viral disease, with ST segment elevation, and higher levels of cardiospecific enzymes. The diagnosis of myocarditis was verified by contrast-enhanced cardiac magnetic resonance imaging.

магнитно-резонансная томография сердцамиокардитотсроченное контрастированиеинфаркт миокардаcardiac magnetic resonance imagingmyocarditisdelayed contrastingmyocardial infarctionReferencesFeldman A.M., McNamara D. Myocarditis. N. Engl. J. Med. 2000; 343 (19): 1388–98.Feldman A.M., McNamara D. Myocarditis. N. Engl. J. Med. 2000; 343 (19): 1388–98.Friedrich M.G. et al. Cardiovascular magnetic resonance in myocarditis. A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53 (17): 1475–87.Friedrich M.G. et al. Cardiovascular magnetic resonance in myocarditis. A JACC White Paper. J. Am. Coll. Cardiol. 2009; 53 (17): 1475–87.Rottgen R. et al. Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters. Eur. Radiol. 2011; 21 (6): 1259–66.Rottgen R. et al. Magnetic resonance imaging findings in acute myocarditis and correlation with immunohistological parameters. Eur. Radiol. 2011; 21 (6): 1259–66.Stensaeth K.H. et al. Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis. Int. J. Cardiovasc. Imaging. 2012; 28 (2): 327–35.Stensaeth K.H. et al. Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis. Int. J. Cardiovasc. Imaging. 2012; 28 (2): 327–35.Палеев Н.Р. Миокардиты. В кн. Чазов Е.И. (ред.) Болезни сердца и сосудов. М.: Медицина; 1992; 2: 178–98. Paleev N.R. Myocarditis. In: Chazov E.I. (ed.) Heart disease and vascular. Moscow: Meditsina; 1992; 2: 178–98 (in Russian).Палеев Н.Р. Миокардиты. В кн. Чазов Е.И. (ред.) Болезни сердца и сосудов. М.: Медицина; 1992; 2: 178–98. Paleev N.R. Myocarditis. In: Chazov E.I. (ed.) Heart disease and vascular. Moscow: Meditsina; 1992; 2: 178–98 (in Russian).Liu P.P., Mason J.W. Advances in the understanding of myocarditis. Circulation. 2001; 104 (9): 1076–82.Liu P.P., Mason J.W. Advances in the understanding of myocarditis. Circulation. 2001; 104 (9): 1076–82.Cooper L.T. et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J. Am. Coll. Cardiol. 2007; 50 (19): 1914–31.Cooper L.T. et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J. Am. Coll. Cardiol. 2007; 50 (19): 1914–31.Синицын В.Е., Стукалова О.В., Ларина О.М., Терновой С.К. Новые возможности диагностики некоронарогенных поражений миокарда: роль магнитно-резонансной томографии. Креативная кардиология. 2008; 1. Sinitsyn V.E., Stukalova O.V., Larina O.M., Ternovoy S.K. New diagnostic capabilities noncoronary myocardial damage: the role of magnetic resonance imaging. Kreativnaya kardiologiya. 2008; 1 (in Russian).Синицын В.Е., Стукалова О.В., Ларина О.М., Терновой С.К. Новые возможности диагностики некоронарогенных поражений миокарда: роль магнитно-резонансной томографии. Креативная кардиология. 2008; 1. Sinitsyn V.E., Stukalova O.V., Larina O.M., Ternovoy S.K. New diagnostic capabilities noncoronary myocardial damage: the role of magnetic resonance imaging. Kreativnaya kardiologiya. 2008; 1 (in Russian).Friedrich M.G. et al. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation. 1998; 97 (18): 1802–9.Friedrich M.G. et al. Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis. Circulation. 1998; 97 (18): 1802–9.Gagliardi M.G. et al. Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am. J. Cardiol. 1991; 68 (10): 1089–91.Gagliardi M.G. et al. Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am. J. Cardiol. 1991; 68 (10): 1089–91.Ammann P. et al. Long-term outcome of acute myocarditis is independent of cardiac enzyme release. Int. J. Cardiol. 2003; 89 (2–3): 217–22.Ammann P. et al. Long-term outcome of acute myocarditis is independent of cardiac enzyme release. Int. J. Cardiol. 2003; 89 (2–3): 217–22.Carniel E. et al. Fatal myocarditis: morphologic and clinical features. Ital. Heart J. 2004; 5 (9): 702–6.Carniel E. et al. Fatal myocarditis: morphologic and clinical features. Ital. Heart J. 2004; 5 (9): 702–6.Abdel-Aty H. et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J. Am. Coll. Cardiol. 2005; 45 (11): 1815–22.Abdel-Aty H. et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J. Am. Coll. Cardiol. 2005; 45 (11): 1815–22.De Cobelli F. et al. Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J. Am. Coll. Cardiol. 2006; 47 (8): 1649–54.De Cobelli F. et al. Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. J. Am. Coll. Cardiol. 2006; 47 (8): 1649–54.Gahide G. et al. MR delayed enhancement imaging findings in suspected acute myocarditis. Eur. Radiol. 2010; 20 (1): 65–72.Gahide G. et al. MR delayed enhancement imaging findings in suspected acute myocarditis. Eur. Radiol. 2010; 20 (1): 65–72.Gutberlet M. et al. Suspected chronic myocarditis at cardiac MR: diagnostic accuracy and association with immunohistologically detected inflammation and viral persistence. Radiology. 2008; 246 (2): 401–9.Gutberlet M. et al. Suspected chronic myocarditis at cardiac MR: diagnostic accuracy and association with immunohistologically detected inflammation and viral persistence. Radiology. 2008; 246 (2): 401–9.Mahrholdt H. et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006; 114 (15): 1581–90.Mahrholdt H. et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006; 114 (15): 1581–90.Laissy J.P. et al. MRI of acute myocarditis: a comprehensive approach based on various imaging sequences. Chest. 2002; 122 (5): 1638–48.Laissy J.P. et al. MRI of acute myocarditis: a comprehensive approach based on various imaging sequences. Chest. 2002; 122 (5): 1638–48.Abdel-Aty H. et al. Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation. 2004; 109 (20): 2411–6.Abdel-Aty H. et al. Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation. 2004; 109 (20): 2411–6.Bohl S. et al. Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease. Int. J. Cardiovasc. Imaging. 2008; 24 (6): 597–607.Bohl S. et al. Delayed enhancement cardiac magnetic resonance imaging reveals typical patterns of myocardial injury in patients with various forms of non-ischemic heart disease. Int. J. Cardiovasc. Imaging. 2008; 24 (6): 597–607.Kim R.J., Judd R.M. Gadolinium￾enhanced magnetic resonance imaging in hypertrophic cardiomyopathy: in vivo imaging of the pathologic substrate for premature cardiac death? J. Am. Coll. Cardiol. 2003; 41 (9): 1568–72.Kim R.J., Judd R.M. Gadolinium￾enhanced magnetic resonance imaging in hypertrophic cardiomyopathy: in vivo imaging of the pathologic substrate for premature cardiac death? J. Am. Coll. Cardiol. 2003; 41 (9): 1568–72.Mahrholdt H. et al. Delayed enhancement cardiovascular magnetic resonance assessment of nonischaemic cardiomyopathies. Eur. Heart J. 2005; 26 (15): 1461–74.Mahrholdt H. et al. Delayed enhancement cardiovascular magnetic resonance assessment of nonischaemic cardiomyopathies. Eur. Heart J. 2005; 26 (15): 1461–74.Laissy J.P. et al. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology. 2005; 237 (1): 75–82.Laissy J.P. et al. Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. Radiology. 2005; 237 (1): 75–82.Zagrosek A. et al. Cardiac magnetic resonance monitors reversible and irreversible myocardial injury in myocarditis. JACC Cardiovasc. Imaging. 2009; 2 (2): 131–8.Zagrosek A. et al. Cardiac magnetic resonance monitors reversible and irreversible myocardial injury in myocarditis. JACC Cardiovasc. Imaging. 2009; 2 (2): 131–8.

The authors declare that there are no conflicts of interest present.