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European Radiology

, Volume 28, Issue 10, pp 4111–4121 | Cite as

Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT

  • S. Oebel
  • S. Hamada
  • K. Higashigaito
  • J. von Spiczak
  • E. Klotz
  • F. Enseleit
  • R. Hinzpeter
  • F. Ruschitzka
  • R. Manka
  • H. Alkadhi
Cardiac
  • 171 Downloads

Abstract

Objectives

We aimed to assess the diagnostic performance of a combined protocol with coronary computed tomography angiography (CCTA) and stress CT perfusion imaging (CTP) in heart transplant patients for comprehensive morphological and functional imaging.

Methods

In this prospective study, 13 patients undergoing routine follow-up 8±6 years after heart transplantation underwent CCTA and dynamic adenosine stress CTP using a third-generation dual-source CT scanner, cardiac magnetic resonance (MR) adenosine stress perfusion imaging at 1.5 T, and catheter coronary angiography. In CCTA stenoses >50% luminal diameter narrowing were noted. Myocardial perfusion deficits were documented in CTP and MR. Quantitative myocardial blood flow (MBF) was calculated with CTP. Left ventricular ejection fraction was determined on cardiac MR cine images. Radiation doses of CT were determined.

Results

One of the 13 patients had to be excluded because of severe motion artifacts. CCTA identified three patients with stenosis >50%, which were confirmed with catheter coronary angiography. CTP showed four patients with stress-induced myocardial hypoperfusion, which were confirmed by MR stress perfusion imaging. Quantitative analysis of global MBF showed lower mean values as compared to known reference values (MBF under stress 125.5 ± 34.5 ml/100 ml/min). Average left ventricular ejection fraction was preserved (56 ± 5%).

Conclusions

In heart transplant patients, a comprehensive CT protocol for the assessment of morphology and function including CCTA and CTP showed good concordance to results from MR perfusion imaging and catheter coronary angiography.

Key Points

• Stress CT perfusion imaging enables the detection of myocardial ischemia

• CT myocardial perfusion imaging can be combined with coronary computed tomography angiography

• Combining perfusion and coronary CT imaging is accurate in heart transplant patients

• CT myocardial perfusion imaging can be performed at a reasonable radiation dose

Keywords

Coronary angiography Multidetector-row computed tomography Magnetic resonance imaging Myocardial perfusion imaging Transplantation 

Abbreviations

bpm

Beats per minute

CAV

Cardiac allograft vasculopathy

CCTA

Coronary computed tomography angiography

CT

Computed tomography

CTP

Computed tomography perfusion

ECG

Electrocardiography

eGFR

Estimated glomerular filtration rate

FoV

Field-of-view

GR

Graft rejection

ISHLT

International society of heart and lung transplantation

LV

Left ventricle

MBF

Myocardial blood flow

MR

Magnetic resonance

mTOR

Mechanistic target of rapamycin

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Hatem Alkadhi.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Ernst Klotz, PhD, is physicist of Siemens Healthcare with an expertise in CT perfusion imaging.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• case-control study

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  2. 2.Department of Cardiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland
  3. 3.Siemens Healthineers, Computed TomographyForchheimGermany

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