Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis

Autor: Laurent Brunereau, Marie Christine Machet, Adrien Auvet, Nicolas Cazeneuve, Thierry Bourguignon, Michel Aupart, Anne Delhommais, Emmanuelle Vermes, Clemence Pantaleon
Rok vydání: 2018
Předmět:
Adult
Graft Rejection
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
Biopsy
T2 mapping
030204 cardiovascular system & hematology
030218 nuclear medicine & medical imaging
03 medical and health sciences
Basal (phylogenetics)
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Tissue markers
Internal medicine
medicine
Humans
Radiology
Nuclear Medicine and imaging
Prospective Studies
Angiology
Extracellular volume fraction
Radiological and Ultrasound Technology
medicine.diagnostic_test
business.industry
Research
Myocardium
Area under the curve
Reproducibility of Results
Magnetic resonance imaging
Middle Aged
Magnetic Resonance Imaging
T1 and T2 mapping
Treatment Outcome
lcsh:RC666-701
Case-Control Studies
Acute Disease
Acute cardiac rejection
Cardiology
Endomyocardial biopsy
Heart Transplantation
Cardiovascular magnetic resonance
Female
Transplant patient
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Cardiovascular Magnetic Resonance
Journal of Cardiovascular Magnetic Resonance, Vol 20, Iss 1, Pp 1-11 (2018)
ISSN: 1532-429X
DOI: 10.1186/s12968-018-0480-9
Popis: Background The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection. Methods CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration. Results Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms [55.0–60.3] vs 51.3 ms [49.5–55.2] (p = 0.007) at basal; 55.7 ms [54.0–59.7] vs 51.8 ms [50.1–53.6] (p = 0.002) at median and 58.2 ms [54.0–63.7] vs 53.6 ms [50.8–57.4] (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% [32.8–37.4] vs 27.4% [24.6–30.6] (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB. Conclusions In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.
Databáze: OpenAIRE
Externí odkaz: