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Format: 04/23/2014
Format: 04/23/2014

News

Allegheny General Hospital Streamlines Testing for Liver Transplant Patients with Advanced Cardiac MRI

Friday, November 15th, 2013

New Study Validates Utility of Cardiac MRI as “One-Stop Shop” for Imaging of Heart, Vessels and Liver
 

Researchers at Allegheny General Hospital (AGH) propose a new “one-stop shop” approach to preoperative testing for liver transplant patients that could greatly streamline the assessment process by substituting one magnetic resonance imaging (MRI)study  for a multitude of other tests.

The results of a two year proof of concept clinical trial conducted by a multidisciplinary team of physicians at AGH will be published today in the medical journal Transplantation.

The AGH study documents the feasibility of performing comprehensive, efficient and safe preoperative cardiac MRI for patients with end stage liver disease who are candidates for transplantation.

Cardiac MRI is a non-invasive diagnostic test that acquires high-resolution and high-fidelity films of the beating heart and displays these results in near-real time and often in 3D. Radiation is not used and injected dyes are typically not required for many indications in cardiac MRI. A cardiac MRI stress test option is now also available and the same technology can be used to acquire detailed imaging of abdomen, including the liver and vascular structures.

Standard preoperative testing for liver transplant has typically involved individual cardiac, vascular and abdominal imaging tests, including echocardiography, nuclear stress tests, and angiography.

“The separate tests in the standard work up can be logistically cumbersome as well as expensive,” said Robert Biederman, MD, Director of Cardiovascular Magnetic Resonance Imaging at Allegheny General. “We wanted to explore whether a comprehensive evaluation could be achieved in a single MRI study.”

The published study results document the cases of 51 patients with chronic liver disease referred to AGH for liver transplant evaluation who underwent concurrent cardiac, vascular and abdominal imaging via cardiac MRI.

The average scan time for the evaluations was 72 minutes. It frequently can take between two and three days for all necessary cardiac assessments to be performed and individual exams within the required panel, such as nuclear testing, can take up to four hours to complete. Cost was not part of the pilot study, but a preliminary cost analysis based on Center for Medicare and Medicaid Services reimbursements from December 2011, showed an average savings of $1,500 when MRI studies were used in place of traditional preoperative evaluations.

“Our institution continually strives to improve patient care and we value the concept of providing not only the best clinical outcomes, but also the most patient-friendly and cost-efficient services,” said Ngoc Thai, MD, PhD, Director of Abdominal Transplantation at AGH. “This more cohesive approach to preoperative imaging not only saves significant time for both patients and medical providers, but the advanced imaging capabilities of cardiac MRI may improve our evaluation process and ultimately result in better patient outcomes.”

Moreover, using MRI technology can facilitate testing in seriously ill patients. Many patients with end stage liver disease fall into this acutely ill patient population, according to Jose Oliva, MD, Medical Director of the hospital’s Liver Transplantation Program.

“Patients with end stage liver disease may present with swelling and fluid buildup in the abdomen and high blood pressure in the vessels of the liver which can cause pain, impair breathing and create other difficulties that make assessment challenging,” Dr. Oliva said.

Patients with contraindications to MRI were excluded from the study by design. The study compared cardiac MRI with standard radiology MRI for detection of hepatocellular carcinoma and found it to be equivalent.  Study results were not compared against other established modalities such as echocardiography or nuclear stress tesing for effectiveness of the screening process. Future evaluations will examine in greater detail the prognostic accuracy of cardiac MRI in correlation with other modalities, patient convenience, and cost-effectiveness.

Sahadev Reddy, MD; Asghar Fakhri, MD; Kusum Tom, MD; Michael Dishart, MD; Mark Doyle PhD; June Yamrozik, BS; Ronald Williams, BA; Saundra Grant, RN; Jacqueline Poydence, RN; Moneal Shah, MD; Anil Singh, MD; and Swami Nathan, MD joined Drs. Biederman, Thai and Oliva in conducting and documenting the research.

Allegheny General Hospital’s Cardiovascular Institute is the only facility in western Pennsylvania to house a dedicated cardiac MRI center for the evaluation of complex cardiovascular diseases. Among a number of pioneering discoveries made by the cardiac MRI team, AGH researchers were also the first to demonstrate that cardiac MRI is better than conventional diagnostics for predicting heart attacks in women.

Home to one of the region’s most comprehensive programs for the treatment of complex liver diseases, Allegheny General Hospital’s Liver Transplantation Program became a Medicare-certified Center for Liver Transplantation in 2010. The program consistently achieves outcomes that meet and exceed national standards as defined by the United Network for Organ Sharing (UNOS).
 
AGH’s multidisciplinary team of highly trained specialists in hepatology, oncology and liver transplantation affords patients access to the complete spectrum of advanced medical and surgical therapies for liver diseases such as hepatitis B and C, auto-immune hepatitis, primary sclerosing cholangitis, fatty liver disease, alcoholic cirrhosis, hemochromatosis and primary liver cancer.

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