Detection and grading of coronary allograft vasculopathy in children with contrast-enhanced magnetic resonance imaging of the coronary vessel wall

Tarique Hussain, Matthew Fenton, Sarah A. Peel, Andrea J. Wiethoff, Andrew Taylor, Vivek Muthurangu, Reza Razavi, Rene M. Botnar, Michael Burch, Gerald F. Greil

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background-Coronary allograft vasculopathy is the leading cause of late death after heart transplantation in children. It is poorly detected by conventional angiography. Intravascular ultrasound is invasive and costly. This study shows that magnetic resonance imaging (MRI) late gadolinium enhancement (LGE) of the coronary vessel wall can detect and grade coronary allograft vasculopathy. Methods and Results-Twenty-four children (10 male; age range, 9-17 years) underwent coronary angiography, intravascular ultrasound, and MRI. Maximal intimal thickness and mean intimal index were recorded. MRI included coronary magnetic resonance angiogram and LGE vessel wall imaging with 1.5 T (n=12) and 3.0 T (n=12). Ten healthy control subjects also underwent LGE MRI. Mean time posttransplantation was 5.5 years (range, 0.25-14 years). Seven patients had Stanford grade IV coronary allograft vasculopathy on intravascular ultrasound, 3 of whom had angiographic disease. Maximal intimal thickness and mean intimal index were 0.73±0.50 mm and 20.9±10.6%, respectively. On MRI, mean diameter of enhancement of vessel wall was 6.57±4.91 mm, and mean enhancement index (indexed to vessel lumen size) was 1.10±1.72. The control group showed little or no LGE. Correlation of LGE with maximal intimal thickness using the Pearson coefficient was 0.80 (P<0.001) and with mean intimal index was 0.92 (P<0.001). An MRI diameter >7.5 mm gave 86% sensitivity and 93% specificity. Conclusions-LGE scores correlate well with traditional intravascular ultrasound measures. These promising early results encourage larger-scale clinical studies to investigate whether LGE MRI will allow closer follow-up and better prevention of coronary allograft vasculopathy in children.

Original languageEnglish (US)
Pages (from-to)91-98
Number of pages8
JournalCirculation: Cardiovascular Imaging
Volume6
Issue number1
DOIs
StatePublished - Jan 1 2013

Fingerprint

Gadolinium
Tunica Intima
Allografts
Coronary Vessels
Magnetic Resonance Imaging
Angiography
Heart Transplantation
Coronary Angiography
Cause of Death
Healthy Volunteers
Magnetic Resonance Spectroscopy
Sensitivity and Specificity
Control Groups

Keywords

  • Coronary artery disease
  • Heart transplantation
  • Intravascular ultrasound
  • MRI
  • Pediatrics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Detection and grading of coronary allograft vasculopathy in children with contrast-enhanced magnetic resonance imaging of the coronary vessel wall. / Hussain, Tarique; Fenton, Matthew; Peel, Sarah A.; Wiethoff, Andrea J.; Taylor, Andrew; Muthurangu, Vivek; Razavi, Reza; Botnar, Rene M.; Burch, Michael; Greil, Gerald F.

In: Circulation: Cardiovascular Imaging, Vol. 6, No. 1, 01.01.2013, p. 91-98.

Research output: Contribution to journalArticle

Hussain, Tarique ; Fenton, Matthew ; Peel, Sarah A. ; Wiethoff, Andrea J. ; Taylor, Andrew ; Muthurangu, Vivek ; Razavi, Reza ; Botnar, Rene M. ; Burch, Michael ; Greil, Gerald F. / Detection and grading of coronary allograft vasculopathy in children with contrast-enhanced magnetic resonance imaging of the coronary vessel wall. In: Circulation: Cardiovascular Imaging. 2013 ; Vol. 6, No. 1. pp. 91-98.
@article{59807815ed8f4dbd89179a1430b83d26,
title = "Detection and grading of coronary allograft vasculopathy in children with contrast-enhanced magnetic resonance imaging of the coronary vessel wall",
abstract = "Background-Coronary allograft vasculopathy is the leading cause of late death after heart transplantation in children. It is poorly detected by conventional angiography. Intravascular ultrasound is invasive and costly. This study shows that magnetic resonance imaging (MRI) late gadolinium enhancement (LGE) of the coronary vessel wall can detect and grade coronary allograft vasculopathy. Methods and Results-Twenty-four children (10 male; age range, 9-17 years) underwent coronary angiography, intravascular ultrasound, and MRI. Maximal intimal thickness and mean intimal index were recorded. MRI included coronary magnetic resonance angiogram and LGE vessel wall imaging with 1.5 T (n=12) and 3.0 T (n=12). Ten healthy control subjects also underwent LGE MRI. Mean time posttransplantation was 5.5 years (range, 0.25-14 years). Seven patients had Stanford grade IV coronary allograft vasculopathy on intravascular ultrasound, 3 of whom had angiographic disease. Maximal intimal thickness and mean intimal index were 0.73±0.50 mm and 20.9±10.6{\%}, respectively. On MRI, mean diameter of enhancement of vessel wall was 6.57±4.91 mm, and mean enhancement index (indexed to vessel lumen size) was 1.10±1.72. The control group showed little or no LGE. Correlation of LGE with maximal intimal thickness using the Pearson coefficient was 0.80 (P<0.001) and with mean intimal index was 0.92 (P<0.001). An MRI diameter >7.5 mm gave 86{\%} sensitivity and 93{\%} specificity. Conclusions-LGE scores correlate well with traditional intravascular ultrasound measures. These promising early results encourage larger-scale clinical studies to investigate whether LGE MRI will allow closer follow-up and better prevention of coronary allograft vasculopathy in children.",
keywords = "Coronary artery disease, Heart transplantation, Intravascular ultrasound, MRI, Pediatrics",
author = "Tarique Hussain and Matthew Fenton and Peel, {Sarah A.} and Wiethoff, {Andrea J.} and Andrew Taylor and Vivek Muthurangu and Reza Razavi and Botnar, {Rene M.} and Michael Burch and Greil, {Gerald F.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1161/CIRCIMAGING.112.975797",
language = "English (US)",
volume = "6",
pages = "91--98",
journal = "Circulation. Cardiovascular imaging",
issn = "1941-9651",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Detection and grading of coronary allograft vasculopathy in children with contrast-enhanced magnetic resonance imaging of the coronary vessel wall

AU - Hussain, Tarique

AU - Fenton, Matthew

AU - Peel, Sarah A.

AU - Wiethoff, Andrea J.

AU - Taylor, Andrew

AU - Muthurangu, Vivek

AU - Razavi, Reza

AU - Botnar, Rene M.

AU - Burch, Michael

AU - Greil, Gerald F.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background-Coronary allograft vasculopathy is the leading cause of late death after heart transplantation in children. It is poorly detected by conventional angiography. Intravascular ultrasound is invasive and costly. This study shows that magnetic resonance imaging (MRI) late gadolinium enhancement (LGE) of the coronary vessel wall can detect and grade coronary allograft vasculopathy. Methods and Results-Twenty-four children (10 male; age range, 9-17 years) underwent coronary angiography, intravascular ultrasound, and MRI. Maximal intimal thickness and mean intimal index were recorded. MRI included coronary magnetic resonance angiogram and LGE vessel wall imaging with 1.5 T (n=12) and 3.0 T (n=12). Ten healthy control subjects also underwent LGE MRI. Mean time posttransplantation was 5.5 years (range, 0.25-14 years). Seven patients had Stanford grade IV coronary allograft vasculopathy on intravascular ultrasound, 3 of whom had angiographic disease. Maximal intimal thickness and mean intimal index were 0.73±0.50 mm and 20.9±10.6%, respectively. On MRI, mean diameter of enhancement of vessel wall was 6.57±4.91 mm, and mean enhancement index (indexed to vessel lumen size) was 1.10±1.72. The control group showed little or no LGE. Correlation of LGE with maximal intimal thickness using the Pearson coefficient was 0.80 (P<0.001) and with mean intimal index was 0.92 (P<0.001). An MRI diameter >7.5 mm gave 86% sensitivity and 93% specificity. Conclusions-LGE scores correlate well with traditional intravascular ultrasound measures. These promising early results encourage larger-scale clinical studies to investigate whether LGE MRI will allow closer follow-up and better prevention of coronary allograft vasculopathy in children.

AB - Background-Coronary allograft vasculopathy is the leading cause of late death after heart transplantation in children. It is poorly detected by conventional angiography. Intravascular ultrasound is invasive and costly. This study shows that magnetic resonance imaging (MRI) late gadolinium enhancement (LGE) of the coronary vessel wall can detect and grade coronary allograft vasculopathy. Methods and Results-Twenty-four children (10 male; age range, 9-17 years) underwent coronary angiography, intravascular ultrasound, and MRI. Maximal intimal thickness and mean intimal index were recorded. MRI included coronary magnetic resonance angiogram and LGE vessel wall imaging with 1.5 T (n=12) and 3.0 T (n=12). Ten healthy control subjects also underwent LGE MRI. Mean time posttransplantation was 5.5 years (range, 0.25-14 years). Seven patients had Stanford grade IV coronary allograft vasculopathy on intravascular ultrasound, 3 of whom had angiographic disease. Maximal intimal thickness and mean intimal index were 0.73±0.50 mm and 20.9±10.6%, respectively. On MRI, mean diameter of enhancement of vessel wall was 6.57±4.91 mm, and mean enhancement index (indexed to vessel lumen size) was 1.10±1.72. The control group showed little or no LGE. Correlation of LGE with maximal intimal thickness using the Pearson coefficient was 0.80 (P<0.001) and with mean intimal index was 0.92 (P<0.001). An MRI diameter >7.5 mm gave 86% sensitivity and 93% specificity. Conclusions-LGE scores correlate well with traditional intravascular ultrasound measures. These promising early results encourage larger-scale clinical studies to investigate whether LGE MRI will allow closer follow-up and better prevention of coronary allograft vasculopathy in children.

KW - Coronary artery disease

KW - Heart transplantation

KW - Intravascular ultrasound

KW - MRI

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=84874513267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874513267&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.112.975797

DO - 10.1161/CIRCIMAGING.112.975797

M3 - Article

C2 - 23223637

AN - SCOPUS:84874513267

VL - 6

SP - 91

EP - 98

JO - Circulation. Cardiovascular imaging

JF - Circulation. Cardiovascular imaging

SN - 1941-9651

IS - 1

ER -