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Acute Cardiac Transplant Rejection: Detection and Grading with MR Imaging with a Blood Pool Contrast Agent—Experimental Study in the Rat¹

¹ From the Departments of Diagnostic Radiology (L.J., E.P., H.A.) and Transplantation Surgery (C.J.), Uppsala University Hospital, Magnetkameran Ing 24, 751 85 Uppsala, Sweden; and Nycomed Amersham Imaging, Oslo, Norway (L.J., A.B.). Received March 29, 2001; revision requested May 21; final revision received March 5, 2002; accepted March 22. Supported in part by a grant from Nycomed Amersham and by the Swedish Medical Research Council project K2001-04X-06676-19A. Address correspondence to L.J. (e-mail: lars.johansson@radiol.uu.se).

View larger version (166K): [in a new window]   Figure 1. MR image shows the positions of the regions of interest in the myocardium (rectangle) and blood (oval).

View larger version (35K): [in a new window]   Figure 2. Box and whisker plot shows the difference in the mean relative SI change in the myocardium between syngeneic and allogeneic transplants on day 2 () and day 6 () after surgery as a function of time after injection of the contrast agent. Error bars indicate bootstrap 95% CIs. On day 2 after transplantation, the confidence level did not change over time after injection, but on day 6 it increased with time. The time points represent the middle of each image acquisition.

View larger version (38K): [in a new window]   Figure 3. Box and whisker plot shows the SI change over time after administration of the contrast agent in the syngeneic (x, n = 6) and allogeneic (, n = 6) groups on day 6 after transplantation. The error bars represent the SD at each time point in the two groups. The time points represent the middle of each image acquisition.

View larger version (194K): [in a new window]   Figure 4a. Photomicrographs of sections of rat cardiac grafts on day 6 after transplantation. The morphologic changes were scored according to a five-step scale, where 1 represents grafts with mild interstitial edema and no or few infiltrating cells and 5 represents grafts with pronounced interstitial edema and massive infiltration. The sections are from (a) a syngeneic graft, grade 1; (b) an allogeneic graft with mild rejection, grade 3; and (c) an allogeneic graft with severe rejection, grade 5. (Mayer hematoxylin-eosin stain; original magnification, x100.)

View larger version (194K): [in a new window]   Figure 4b. Photomicrographs of sections of rat cardiac grafts on day 6 after transplantation. The morphologic changes were scored according to a five-step scale, where 1 represents grafts with mild interstitial edema and no or few infiltrating cells and 5 represents grafts with pronounced interstitial edema and massive infiltration. The sections are from (a) a syngeneic graft, grade 1; (b) an allogeneic graft with mild rejection, grade 3; and (c) an allogeneic graft with severe rejection, grade 5. (Mayer hematoxylin-eosin stain; original magnification, x100.)

View larger version (193K): [in a new window]   Figure 4c. Photomicrographs of sections of rat cardiac grafts on day 6 after transplantation. The morphologic changes were scored according to a five-step scale, where 1 represents grafts with mild interstitial edema and no or few infiltrating cells and 5 represents grafts with pronounced interstitial edema and massive infiltration. The sections are from (a) a syngeneic graft, grade 1; (b) an allogeneic graft with mild rejection, grade 3; and (c) an allogeneic graft with severe rejection, grade 5. (Mayer hematoxylin-eosin stain; original magnification, x100.)

View larger version (64K): [in a new window]   Figure 5a. In a and b, LV = left ventricle, RV = right ventricle. (a) Three MR images of an allogeneic transplant, acquired at 1, 15, and 30 minutes after injection. The increase in SI in the myocardium from 1 to 30 minutes after injection is approximately 20% in this case. The increased SI adjacent to the left ventricle is probably a result of leakage of contrast agent into pericardial fluid. (b) Three MR images of a syngeneic transplant, acquired at 1, 15, and 30 minutes after injection. The decrease in SI from 1 to 30 minutes after injection is approximately 5%, which may make appreciation of the decrease hard on these images.

View larger version (58K): [in a new window]   Figure 5b. In a and b, LV = left ventricle, RV = right ventricle. (a) Three MR images of an allogeneic transplant, acquired at 1, 15, and 30 minutes after injection. The increase in SI in the myocardium from 1 to 30 minutes after injection is approximately 20% in this case. The increased SI adjacent to the left ventricle is probably a result of leakage of contrast agent into pericardial fluid. (b) Three MR images of a syngeneic transplant, acquired at 1, 15, and 30 minutes after injection. The decrease in SI from 1 to 30 minutes after injection is approximately 5%, which may make appreciation of the decrease hard on these images.