Bogot Naama R, Durst Ronen, Shaham Dorith, Admon Dan
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Radiographics. 2007 Sep-Oct;27(5):1297-309. doi: 10.1148/rg.275065107.
Effective antirejection therapy and infection control have significantly improved the long-term survival of heart transplant recipients, but coronary allograft vasculopathy remains an important limiting factor. Most heart transplant recipients undergo annual coronary angiography for the detection of allograft vasculopathy, which is often clinically silent. Angiography allows detection of vasculopathy only indirectly, with depiction of the lumen, and does not depict the wall thickening and intimal hyperplasia that typify this disease; the procedure also is invasive and is associated with a 1%-2% risk of complication. In contrast, electrocardiographically gated multidetector computed tomography (CT) can provide a comprehensive and noninvasive evaluation of the transplanted heart in a single study. Cardiac CT enables evaluation of the coronary artery lumen and wall and thus may be used for screening, diagnosis, grading, and follow-up of coronary allograft vasculopathy. It also may be used to detect other posttransplantation complications, such as malignancy and infection, and to assess cardiac and vascular anastomoses and cardiac function. However, special strategies may be needed to reduce the transplant heart rate so as to obtain images of diagnostic quality.
有效的抗排斥治疗和感染控制显著提高了心脏移植受者的长期生存率，但移植心脏冠状动脉病变仍然是一个重要的限制因素。大多数心脏移植受者每年接受冠状动脉造影以检测移植心脏血管病变，这种病变在临床上通常没有症状。血管造影只能间接检测血管病变，通过描绘管腔来进行，无法显示代表这种疾病的血管壁增厚和内膜增生；该检查也是侵入性的，且有1%-2%的并发症风险。相比之下，心电图门控多排螺旋计算机断层扫描（CT）可以在一次检查中对移植心脏进行全面的无创评估。心脏CT能够评估冠状动脉管腔和血管壁，因此可用于移植心脏冠状动脉病变的筛查、诊断、分级和随访。它还可用于检测其他移植后并发症，如恶性肿瘤和感染，并评估心脏和血管吻合口以及心脏功能。然而，可能需要特殊策略来降低移植心脏的心率，以获得具有诊断质量的图像。
