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Acute Pancreatic Transplant Rejection: Evaluation with Dynamic Contrast-enhanced MR Imaging Compared with Histopathologic Analysis

¹ Departments of Diagnostic Radiology (T.L.K., B.D., J.J.W.Y.C., K.C.)
² Surgery (S.T.B.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201.

View larger version (16K): [in a new window]   Figure 1. Average of MPPEs measured over 5 minutes plotted according to histopathologic diagnoses of normal, mild, moderate, and severe acute rejection and of infarction.

View larger version (9K): [in a new window]   Figure 2. Scatter diagram shows the range of MPPEs at 1 minute with histopathologic diagnoses of normal, mild, moderate, and severe acute rejection and of infarction.

View larger version (194K): [in a new window]   Figure 3a. Coronal fast multiplanar spoiled GRE MR images (150/4.2, 60° flip angle) obtained in a patient with a normal pancreas allograft, as confirmed at percutaneous biopsy. (a) Unenhanced image and (b) image obtained 1 minute after the administration of gadolinium-based contrast material demonstrate avid enhancement throughout a normal-sized pancreatic allograft (straight arrows). Note the adjacent enteric anastomosis (curved arrow) and renal allograft (arrowheads). The measured MPPE was 122%.

View larger version (195K): [in a new window]   Figure 3b. Coronal fast multiplanar spoiled GRE MR images (150/4.2, 60° flip angle) obtained in a patient with a normal pancreas allograft, as confirmed at percutaneous biopsy. (a) Unenhanced image and (b) image obtained 1 minute after the administration of gadolinium-based contrast material demonstrate avid enhancement throughout a normal-sized pancreatic allograft (straight arrows). Note the adjacent enteric anastomosis (curved arrow) and renal allograft (arrowheads). The measured MPPE was 122%.

View larger version (191K): [in a new window]   Figure 4. Coronal fast multiplanar spoiled GRE MR image (150/4.2, 60° flip angle) obtained 1 minute after the administration of gadolinium-based contrast material in a patient with moderate acute rejection of pancreatic allograft, as confirmed at percutaneous biopsy. Image demonstrates diminished enhancement (straight arrows) compared with the enhancement in the pancreas in Figure 3b. Mild hydronephrosis of the renal transplant (curved arrow) is noted. The measured MPPE was 72%.

View larger version (198K): [in a new window]   Figure 5. Coronal fast multiplanar spoiled GRE MR image (150/4.2, 60° flip angle) obtained 1 minute after the administration of gadolinium-based contrast material in a patient with pancreatic allograft infarction that was proved at surgical explantation. There is no enhancement in the enlarged pancreatic allograft (white arrows) or in the duodenal cuff (black arrow). The measured MPPE was 1%. A normal enhancing renal transplant (arrowheads) is noted.