Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT
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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.
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.
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%).
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.
• 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
KeywordsCoronary angiography Multidetector-row computed tomography Magnetic resonance imaging Myocardial perfusion imaging Transplantation
Beats per minute
Cardiac allograft vasculopathy
Coronary computed tomography angiography
Computed tomography perfusion
Estimated glomerular filtration rate
International society of heart and lung transplantation
Myocardial blood flow
Mechanistic target of rapamycin
The authors state that this work has not received any funding.
Compliance with ethical standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
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