ABSTRACT
Objective:
To evaluate the diagnostic value of cardiac
magnetic resonance (CMR) in
myocardial contusion.
Methods:
A
case-control study was performed on 42
patients with blunt
chest injury treated in Affiliated
Hospital of Hangzhou Normal
University from September 2018 to January 2021. There were 24
males and 18
females, with the age range of 23-66 years [(44.2±10.9)years]. The
patients were divided into
myocardial contusion group ( n=20) and non-
myocardial contusion group ( n=22) according to the clinical diagnostic criteria of
myocardial contusion (cardiac
troponin I>0.06 ng/ml). All the
patients underwent CMR examination within 7 days after
hospitalization, and eletrocardiography (
ECG) as well as
transthoracic echocardiography (TTE) examinations with 24 hours. Abnormal findings on CMR,
ECG and TTE were compared between the two groups. The
receiver operating characteristic (ROC) curve was used for the comparison of the diagnostic
efficacy of CMR,
ECG and TTE for
myocardial contusion. The area under the curve (
AUC),
sensitivity,
specificity,
positive predictive value and Youden index of CMR,
ECG and TTE were calculated, respectively.
Results:
There were 15
patients (75%) presenting CMR
abnormalities in
myocardial contusion group compared to 2
patients (9%) in non-
myocardial contusion group ( P<0.01). CMR
abnormalities mainly included myocardial oedema,
ischemia or
hemorrhage, which were located in the
left ventricle of 12
patients (71%),
right ventricle of 3 (18%) and ventricular septal of 3 (12%). There were 12
patients (60%) showing
ECG abnormalities in
myocardial contusion group compared to 7
patients (32%) in non-
myocardial contusion group ( P>0.05). Abnormal
ECG changes included 8
patients (42%) with
sinus tachycardia or
bradycardia, 5 (26%) with ST-T changes, 3 (16%) with atrial
premature beat, 2 (11%) with
bundle branch block and 1 (5%) with frequent
premature ventricular contractions. There were 10
patients (50%) showing TTE
abnormalities in
myocardial contusion group compared to 9
patients (41%) in non-
myocardial contusion group ( P>0.05). TTE
abnormalities manifested as
left ventricular diastolic dysfunction in 12
patients (63%) and wall
motion abnormalities in 7 (37%). The
AUC of CMR,
ECG and TTE for diagnosing
myocardial contusion was 0.83 (95% CI 0.70-0.96), 0.64 (95% CI 0.47-0.81) and 0.55 (95% CI 0.70-0.72), respectively. For CMR,
ECG and TTE, the diagnostic
sensitivity was 75.0%, 60.0% and 50.0%, with the
specificity of 91.0%, 68.2% and 59.1%, the
positive predictive value was 88.2%, 63.2% and 52.6%, and the Youden index of 66.0, 28.2 and 9.1, respectively.
Conclusion:
CMR can accurately detect
myocardial contusion, with better diagnostic performance than
ECG and TTE as well as relatively higher
sensitivity and specificity, indicating that CMR has great value for
clinical diagnosis of
myocardial contusion.