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European Radiology
Published in: European Radiology 10/2014

Open Access 01-10-2014 | Cardiac

Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy

Authors: Christian Krieghoff, Markus J. Barten, Lysann Hildebrand, Matthias Grothoff, Lukas Lehmkuhl, Christian Lücke, Claudia Andres, Stefan Nitzsche, Franziska Riese, Martin Strüber, Friedrich Wilhelm Mohr, Matthias Gutberlet

Published in: European Radiology | Issue 10/2014

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Abstract

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.
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Metadata
Title
Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy
Authors
Christian Krieghoff
Markus J. Barten
Lysann Hildebrand
Matthias Grothoff
Lukas Lehmkuhl
Christian Lücke
Claudia Andres
Stefan Nitzsche
Franziska Riese
Martin Strüber
Friedrich Wilhelm Mohr
Matthias Gutberlet
Publication date
01-10-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3246-2

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