Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy
| Autor: | Markus J. Barten, Lysann Hildebrand, S Nitzsche, Christian Krieghoff, C Andres, Matthias Grothoff, Martin Strüber, Christian Lücke, Matthias Gutberlet, Franziska Riese, Friedrich W. Mohr, Lukas Lehmkuhl |
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| Rok vydání: | 2014 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty Biopsy medicine.medical_treatment Magnetic Resonance Imaging Cine Endomyocardial biopsy Magnetic resonance imaging Predictive Value of Tests Cardiac magnetic resonance imaging Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Graft rejection/diagnosis Retrospective Studies Neuroradiology Inflammation Heart transplantation medicine.diagnostic_test business.industry Myocardium Ultrasound Interventional radiology General Medicine Middle Aged Allografts Heart/transplantation Myocarditis ROC Curve Radiology Nuclear Medicine and imaging Predictive value of tests Acute Disease cardiovascular system Cardiology Heart Transplantation Female Radiology business Cardiac Follow-Up Studies |
| Zdroj: | European Radiology |
| ISSN: | 1432-1084 0938-7994 |
| Popis: | Objective Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection. Methods One hundred and forty-six examinations in 73 patients (mean age 53 ± 12 years, 58 men) were performed using a 1.5 Tesla system and compared to EMB. Examinations included a STIR (short tau inversion recovery) sequence for calculation of edema ratio (ER), a T1-weighted spin-echo sequence for assessment of global relative enhancement (gRE), and inversion-recovery sequences to visualize late gadolinium enhancement (LGE). Histological grade ≥1B was considered relevant rejection. Results One hundred and twenty-seven (127/146 = 87 %) EMBs demonstrated no or mild signs of rejection (grades ≤1A) and 19/146 (13 %) a relevant rejection (grade ≥1B). Sensitivity, specificity, positive predictive, and negative predictive values were as follows: ER: 63 %, 78 %, 30 %, and 93 %; gRE: 63 %, 70 %, 24 %, and 93 %; LGE: 68 %, 36 %, 13 %, and 87 %; with the combination of ER and gRE with at least one out of two positive: 84 %, 57 %, 23 %, and 96 %. ROC analysis revealed an area under the curve of 0.724 for ER and 0.659 for gRE. Conclusion CMR parameters for myocarditis are useful to detect sub-clinical acute cellular rejection after heart transplantation. Comparable results to myocarditis can be achieved with a combination of parameters. Key Points • Magnetic resonance imaging is useful for the assessment of cardiac allograft rejection. • CMR has a high negative predictive value for exclusion of allograft rejection. • Diagnostic performance is not yet good enough to replace endomyocardial biopsy. |
| Databáze: | OpenAIRE |
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