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

作者：Krieghoff Christian^*; Barten Markus J; Hildebrand Lysann; Grothoff Matthias; Lehmkuhl Lukas; Luecke Christian; Andres Claudia; Nitzsche Stefan; Riese Franziska; Strueber Martin; Mohr Friedrich Wilhelm; Gutberlet Matthias

来源：European Radiology, 2014, 24(10): 2360-2371.

DOI：10.1007/s00330-014-3246-2

• Heart/transplantation
• Graft rejection/diagnosis
• Magnetic resonance imaging
• Inflammation
• Myocarditis

Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection. %26lt;br%26gt;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 a parts per thousand yen1B was considered relevant rejection. %26lt;br%26gt;One hundred and twenty-seven (127/146 = 87 %) EMBs demonstrated no or mild signs of rejection (grades a parts per thousand currency sign1A) and 19/146 (13 %) a relevant rejection (grade a parts per thousand yen1B). 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. %26lt;br%26gt;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. %26lt;br%26gt;aEuro cent Magnetic resonance imaging is useful for the assessment of cardiac allograft rejection. %26lt;br%26gt;aEuro cent CMR has a high negative predictive value for exclusion of allograft rejection. %26lt;br%26gt;aEuro cent Diagnostic performance is not yet good enough to replace endomyocardial biopsy.

• 出版日期2014-10