title: Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Leipzig - Heart Centre, Leipzig, Germany, christian.krieghoff@herzzentrum-leipzig.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Krieghoff
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Barten
authors.forename: Lysann
authors.initials: L
authors.lastname: Hildebrand
authors.forename: Matthias
authors.initials: M
authors.lastname: Grothoff
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehmkuhl
authors.forename: Christian
authors.initials: C
authors.lastname: Lücke
authors.forename: Claudia
authors.initials: C
authors.lastname: Andres
authors.forename: Stefan
authors.initials: S
authors.lastname: Nitzsche
authors.forename: Franziska
authors.initials: F
authors.lastname: Riese
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
mesh_terms: D000208:Acute Disease; D064591:Allografts; D001706:Biopsy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis*; D016027:Heart Transplantation; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies