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Quantitative cardiac magnetic resonance T2 imaging offers ability to non-invasively predict acute allograft rejection in children

Published online by Cambridge University Press:  27 May 2020

Neeta Sethi Open the ORCID record for Neeta Sethi [Opens in a new window] ,
Ashish Doshi ,
Tina Doshi ,
Russell Cross ,
Ileen Cronin ,
Elena Amin ,
Joshua Kanter ,
Janet Scheel ,
Sairah Khan  and
Adrienne Campbell-Washburn
...Show all authors
Neeta Sethi
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
Ashish Doshi
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD21218, USA
Tina Doshi
Affiliation:
Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD21205, USA
Russell Cross
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
Ileen Cronin
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
Elena Amin
Affiliation:
Department of Pediatrics, University of California San Francisco, San Francisco, CA94143, USA
Joshua Kanter
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
Janet Scheel
Affiliation:
Division of Cardiology, St. Louis Children’s Hospital, St. Louis, MO, 63110, USA
Sairah Khan
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
Adrienne Campbell-Washburn
Affiliation:
National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
Laura Olivieri*
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC20010, USA
*
Author for correspondence: Laura Olivieri, MD, 111 Michigan Avenue NW, W3-200, Washington, DC20010, USA. Tel: +1 202 476 2020; Fax: +1 202 476 3900. E-mail: lolivieri@childrensnational.org
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Abstract

Background:

Monitoring for acute allograft rejection improves outcomes after cardiac transplantation. Endomyocardial biopsy is the gold standard test defining rejection, but carries risk and has limitations. Cardiac magnetic resonance T2 mapping may be able to predict rejection in adults, but has not been studied in children. Our aim was to evaluate T2 mapping in identifying paediatric cardiac transplant patients with acute rejection.

Methods:

Eleven paediatric transplant patients presenting 18 times were prospectively enrolled for non-contrast cardiac magnetic resonance at 1.5 T followed by endomyocardial biopsy. Imaging included volumetry, flow, and T2 mapping. Regions of interest were manually selected on the T2 maps using the middle-third technique in the left ventricular septal and lateral wall in a short-axis and four-chamber slice. Mean and maximum T2 values were compared with Student’s t-tests analysis.

Results:

Five cases of acute rejection were identified in three patients, including two cases of grade 2R on biopsy and three cases of negative biopsy treated for clinical symptoms attributed to rejection (new arrhythmia, decreased exercise capacity). A monotonic trend between increasing T2 values and higher biopsy grades was observed: grade 0R T2 53.4 ± 3 ms, grade 1R T2 54.5 ms ± 3 ms, grade 2R T2 61.3 ± 1 ms. The five rejection cases had significantly higher mean T2 values compared to cases without rejection (58.3 ± 4 ms versus 53 ± 2 ms, p = 0.001).

Conclusions:

Cardiac magnetic resonance with quantitative T2 mapping may offer a non-invasive method for screening paediatric cardiac transplant patients for acute allograft rejection. More data are needed to understand the relationship between T2 and rejection in children.

Keywords

Paediatriccardiac magnetic resonanceT2 mappingheart transplantallograft rejection
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 852 - 859
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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