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Published on: February 16, 2016
Qualitative Perfusion Cardiac Magnetic Resonance Imaging Lacks Sensitivity in Detecting Cardiac Allograft
Monica Colvin-Adams1, Salam Petros1, Ganesh Raveendran1
1University of Minnesota, Cardiovascular Division, Minneapolis, MN 55455, USA.
Insights
Qualitative perfusion cardiac MRI has low sensitivity (41%) and moderate specificity (74%) for detecting cardiac allograft vasculopathy (CAV). This noninvasive imaging technique may be improved with disease severity for CAV surveillance.
Area of Science:
- Cardiology
- Radiology
- Transplant Medicine
Background:
- Cardiac allograft vasculopathy (CAV) is a significant post-heart transplant complication.
- Current surveillance via coronary angiography is invasive and has limitations in sensitivity.
- Perfusion MRI offers a potential noninvasive alternative for CAV assessment.
Purpose of the Study:
- To compare the diagnostic accuracy of qualitative perfusion MRI with coronary angiography in detecting CAV.
- To evaluate MRI as a noninvasive tool for CAV surveillance.
Main Methods:
- Retrospective analysis of 68 heart transplant recipients with simultaneous cardiac MRI and coronary angiography.
- Comparison of qualitative MRI findings to coronary angiogram results.
- Calculation of sensitivity and specificity for MRI in detecting CAV.
Main Results:
- Overall sensitivity of qualitative perfusion MRI for CAV detection was 41%, with a specificity of 74%.
- MRI performance showed a slight improvement in sensitivity with increasing disease severity.
- Patient demographics included 73.5% males with a mean age of 45.37 years.
Conclusions:
- Qualitative perfusion cardiac MRI demonstrates low sensitivity and moderate specificity for CAV detection.
- MRI may have a limited role in current CAV surveillance protocols.
- Further research into advanced MRI techniques could enhance its utility for CAV.
Background:
Cardiac allograft vasculopathy (CAV) is a major complication after heart transplantation, requiring frequent surveillance angiography. Though cardiac angiography is the gold standard, it is insensitive in detecting transplant vasculopathy and invasive. Perfusion MRI provides a noninvasive alternative and possibly a useful modality for studying CAV. We sought to compare the accuracy of qualitative perfusion MRI to coronary angiography in detecting CAV.
Methods:
A retrospective analysis was performed in 68 heart transplant recipients who had simultaneous surveillance cardiac MRI and coronary angiogram and who underwent transplantation between 2000 and 2007. We compared results of qualitative MRI to those of the cardiac angiogram. Sensitivity and specificity of MR were calculated.
Results:
Sixty-eight patients underwent both cardiac MRI and coronary angiogram. 73.5% were male; mean age was 45.37 ± 14 years. Mean duration of heart transplantation was 7.9 ± 5.2 years. The mean ejection fraction was 55% in the patients without CAV and 57.4% in those with CAV. There were 48 normal and 24 abnormal MRI studies. The overall sensitivity was 41% and specificity was 74%.
Conclusions:
Qualitative assessment of perfusion cardiac MR has low sensitivity and moderate specificity for detecting CAV. The sensitivity of MRI was slightly improved with severity of disease.
