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Assessment of sub-clinical acute cellular rejection after heart transplantation: Comparison of cardiac magnetic resonance imaging and endomyocardial biopsy

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Journal of Cardiovascular Magnetic Resonance201416 (Suppl 1) :P276

  • Published:


  • Cardiac Magnetic Resonance
  • Myocarditis
  • Late Gadolinium Enhancement
  • Cardiac Magnetic Resonance Imaging
  • Endomyocardial Biopsy


To compare the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) as the standard of reference for sub-clinical cardiac allograft rejection.


On-hundred-forty-six CMR examinations in 73 Patients (mean age 53 ± 12 years, 58 male) were performed using a 1.5 Tesla MR scanner and compared to EMB results. A multi-sequential protocol including a T2-weighted STIR (short tau inversion recovery) sequence for calculation of the edema ratio (ER), a T1-weighted spin-echo sequence for the assessment of the global relative enhancement (gRE) as well as inversion-recovery sequences to visualize late gadolinium enhancement (LGE), with the same cut-off values for ER (≥2) and gRE (≥4.5) as for myocarditis was used. The presence of LGE was assessed qualitatively only. A histological grade ≥1B was considered as relevant rejection in which all patients received anti-inflammatory medical treatment.


One-hundred-twenty-seven (127/146 = 87%) EMBs demonstrated with no or mild signs of rejection (grades ≤1A) and 19/146 (13%) with a relevant rejection (grade ≥1B). Sensitivity, specificity, positive predictive (PPV) and negative predictive value (NPV) for rejection grade 1B or higher 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 1 out of 2 positive: 84%, 57%, 23% and 96%. A receiver operator characteristic analysis revealed an area under the curve of 0.724 for ER and 0.659 for gRE.


CMR parameters for myocarditis were also useful to detect sub-clinical acute cellular rejection after heart transplantation. Comparable results to myocarditis could be achieved, with a combination of parameters.


No funding.

Authors’ Affiliations

Diagnostic and Interventional Radiology, University Leipzig - Heart Center, Leipzig, Germany
Cardiac Surgery, University Leipzig - Heart Center, Leipzig, Germany


© Gutberlet et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.