Krieghoff Christian, Barten Markus J, Hildebrand Lysann, Grothoff Matthias, Lehmkuhl Lukas, Lücke Christian, Andres Claudia, Nitzsche Stefan, Riese Franziska, Strüber Martin, Mohr Friedrich Wilhelm, Gutberlet Matthias
Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Leipzig, Germany,
Eur Radiol. 2014 Oct;24(10):2360-71. doi: 10.1007/s00330-014-3246-2. Epub 2014 Jun 4.
Comparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection.
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.
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.
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.
• 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.
比较多序列心脏磁共振成像（CMR）与心内膜心肌活检（EMB）对亚临床心脏移植排斥反应的诊断价值。
使用1.5特斯拉系统对73例患者（平均年龄53±12岁，58例男性）进行了146次检查，并与EMB进行比较。检查包括用于计算水肿率（ER）的短tau反转恢复（STIR）序列、用于评估整体相对强化（gRE）的T1加权自旋回波序列以及用于观察延迟钆增强（LGE）的反转恢复序列。组织学分级≥1B被视为有意义的排斥反应。
127例（127/146 = 87%）EMB显示无排斥反应或仅有轻度排斥反应迹象（分级≤1A），19/146例（13%）有意义的排斥反应（分级≥1B）。敏感性、特异性、阳性预测值和阴性预测值如下：ER：63%、78%、30%和93%；gRE：63%、70%、24%和93%；LGE：68%、36%、13%和87%；ER和gRE两者中至少有一项为阳性的联合检测：84%、57%、23%和96%。ROC分析显示ER的曲线下面积为0.724，gRE的曲线下面积为0.659。
心肌炎的CMR参数有助于检测心脏移植后的亚临床急性细胞排斥反应。参数联合检测可获得与心肌炎相当的结果。
• 磁共振成像对评估心脏移植排斥反应有用。• CMR对排除移植排斥反应具有较高的阴性预测值。• 诊断性能尚不足以取代心内膜心肌活检。
