Pediatric/Congenital Heart Disease Section February 2022 Business Meeting-Congenital CMR Case Conference 2022-02-23

Video Transcription

Video Summary

The session opened with conference housekeeping from LaDonna Malone and Ujatha Boode, welcoming more than 200 international registrants and asking participants to stay muted with video off, submit questions in chat, and use the hand-raise feature for live discussion.<br /><br />The first major presentation, by Dr. James Carr, reviewed MRI of the transplant heart. He explained the major post-transplant complications: acute rejection in the first year, and chronic allograft vasculopathy (CAV) afterward. He emphasized that rejection can be asymptomatic and that current surveillance relies heavily on invasive tests such as endomyocardial biopsy, angiography, and IVUS, which are costly and can miss patchy or diffuse disease. Dr. Carr highlighted the growing role of cardiac MRI, including cine imaging, late gadolinium enhancement, T1/T2 mapping, extracellular volume (ECV), tissue phase mapping, and stress perfusion. His work and others suggest that T2 and ECV may help detect rejection, while quantitative perfusion imaging may detect CAV and correlate with invasive findings. He also discussed future directions such as CTA, PET, and hybrid MR-PET.<br /><br />The second presentation, by Dr. John Soslow, focused on pediatric transplant imaging. He explained that pediatric transplant patients differ substantially from adults in diagnosis mix, donor selection, surgical technique, immunosuppression, and imaging needs. He reviewed MRI findings in healthy transplanted hearts, acute rejection, and CAV, stressing that pediatric-specific normal values and validated cutoffs are needed. He presented evidence that multiparametric MRI may help screen for rejection and CAV, but larger multicenter pediatric studies are still needed.<br /><br />The session ended with questions about buy-in from transplant teams, timing of MRI, differentiating rejection from other inflammation, and insurance coverage. Both speakers agreed MRI is promising as an adjunct, not a replacement, for biopsy.

Keywords

cardiac MRI

heart transplant

acute rejection

chronic allograft vasculopathy

endomyocardial biopsy

T1/T2 mapping

extracellular volume

stress perfusion

pediatric transplant imaging

multiparametric MRI