title: Exploratory use of cardiovascular magnetic resonance imaging in liver transplantation: a one-stop shop for preoperative cardiohepatic evaluation.
abstract: BACKGROUND
  Preoperative cardiovascular risk stratification in orthotopic liver transplantation candidates has proven challenging due to limitations of current noninvasive modalities. Additionally, the preoperative workup is logistically cumbersome and expensive given the need for separate cardiac, vascular, and abdominal imaging. We evaluated the feasibility of a "one-stop shop" in a magnetic resonance suite, performing assessment of cardiac structure, function, and viability, along with simultaneous evaluation of thoracoabdominal vasculature and liver anatomy.
  
  
  METHODS
  In this pilot study, patients underwent steady-state free precession sequences and stress cardiac magnetic resonance (CMR), thoracoabdominal magnetic resonance angiography, and abdominal magnetic resonance imaging (MRI) on a standard MRI scanner. Pharmacologic stress was performed using regadenoson, adenosine, or dobutamine. Viability was assessed using late gadolinium enhancement.
  
  
  RESULTS
  Over 2 years, 51 of 77 liver transplant candidates (mean age, 56 years; 35% female; mean Model for End-stage Liver Disease score, 10.8; range, 6-40) underwent MRI. All referred patients completed standard dynamic CMR, 98% completed stress CMR, 82% completed late gadolinium enhancement for viability, 94% completed liver MRI, and 88% completed magnetic resonance angiography. The mean duration of the entire study was 72 min, and 45 patients were able to complete the entire examination. Among all 51 patients, 4 required follow-up coronary angiography (3 for evidence of ischemia on perfusion CMR and 1 for postoperative ischemia), and none had flow-limiting coronary disease. Nine proceeded to orthotopic liver transplantation (mean 74 days to transplantation after MRI). There were six ascertained mortalities in the nontransplant group and one death in the transplanted group. Explant pathology confirmed 100% detection/exclusion of hepatocellular carcinoma. No complications during CMR examination were encountered.
  
  
  CONCLUSIONS
  In this proof-of-concept study, it appears feasible to perform a comprehensive, efficient, and safe preoperative liver transplant imaging in a CMR suite-a one-stop shop, even in seriously ill patients.
authors: 1 Gerald McGinnis Cardiovascular Institute, Pittsburgh, PA. 2 Surgery, Allegheny General Hospital, Pittsburgh, PA. 3 Anesthesiology, Allegheny General Hospital, Pittsburgh, PA. 4 Gastroenterology, Allegheny General Hospital, Pittsburgh, PA. 5 Pulmonary, Allegheny General Hospital, Pittsburgh, PA. 6 Psychology, Allegheny General Hospital, Pittsburgh, PA. 7 Address correspondence to: Robert W.W. Biederman, M.D., F.A.C.C., F.A.H.A., Department of Cardiovascular MRI, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212.
authors: Sahadev T
authors: ST
authors: Reddy
authors: Ngoc L
authors: NL
authors: Thai
authors: Asghar A
authors: AA
authors: Fakhri
authors: Jose
authors: J
authors: Oliva
authors: Kusum B
authors: KB
authors: Tom
authors: Michael K
authors: MK
authors: Dishart
authors: Mark
authors: M
authors: Doyle
authors: June A
authors: JA
authors: Yamrozik
authors: Ronald B
authors: RB
authors: Williams
authors: Saundra B
authors: SB
authors: Grant
authors: Jacqueline
authors: J
authors: Poydence
authors: Moneal
authors: M
authors: Shah
authors: Anil
authors: A
authors: Singh
authors: Swami
authors: S
authors: Nathan
authors: Robert W W
authors: RW
authors: Biederman
mesh_terms: D000241:Adenosine; D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003287:Contrast Media; D017023:Coronary Angiography; D004280:Dobutamine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011687:Purines; D011720:Pyrazoles
chemical_list: D003287:Contrast Media; D011687:Purines; D011720:Pyrazoles; C430916:regadenoson; D004280:Dobutamine; D000241:Adenosine