For transplant Recipients, A One-Stop MRI

By Joe Smydo / Pittsburgh Post-Gazette

Amid positive reviews from patients and a successful clinical trial, Allegheny Health System hopes that its streamlined regimen of pre-operative testing for prospective liver recipients one day might be adapted to patients awaiting other kinds of transplants and procedures.

The health system’s expanded use of magnetic resonance imaging enables doctors to eliminate the need for separate echocardiograms and nuclear stress tests for some patients.

Instead, with one MRI lasting about 70 minutes, doctors can evaluate the cardiac and vascular systems and scan the liver, too. The combined test is called a cardiac MRI. Results of a clinical trial, involving 51 patients over two years, was published in the Nov. 15 issue of the journal Transplantation.

Doctors said the test saves patients the hassle of making separate trips to the hospital for the echocardiogram, nuclear stress test and liver MRI. The nuclear stress test alone may take two to three hours, and patients with advanced liver disease often struggle with such a grueling schedule.

“In the end, the patients have to be able to sit still for these tests,” said Robert W. Biederman, director of cardiac MRI at Allegheny General Hospital.

Quality is not sacrificed by the new testing regimen; the MRI actually provides better information about the cardiac and vascular systems than the other tests, said Ngoc Thai, director of abdominal transplantation for the health system.

Evaluations of the heart and vascular system are necessary to ensure that a patient can handle the stress of a liver transplant. “It is a very demanding operation,” Dr. Thai said.

The non-invasive cardiac MRI provides high-resolution and three-dimensional images of the heart, vascular system and liver in near-real time. Radiation used in the nuclear stress test is not needed for the MRI, and dyes used in the nuclear stress test often aren’t needed, either.

On a recent Friday, MRI technologists Ronald Williams and June Yamrozik, members of the team that performed the clinical trial, steered James Vanfosson, 59, through the tests at Allegheny General. As Mr. Vanfosson lay in the MRI machine, images of his heart and liver appeared on a bank of computer screens that Mr. Williams and Ms. Yamrozik monitored in an adjoining room.

Mr. Williams observed Mr. Vanfosson through a large window and spoke with him over a microphone.

“You’re going to feel the table move a little bit, Jim. That’s normal. I’m just taking a couple of pictures of your liver,” Mr. Williams said at one point. Tongue in cheek, he asked Mr. Vanfosson, “Isn’t this fun?”

While it wasn’t fun, Mr. Vanfosson, a retired coal miner with cirrhosis, said he was pleased that the streamlined testing eliminated two trips to the North Side hospital from his home in Fairmont, W.Va.

In addition to saving patients time, doctors said, the new procedure could be less costly.

The health system said it doesn’t know of any other U.S. health system using the cardiac MRI in this way. Dr. Biederman said he’d like to see the streamlined testing applied to other transplants and to procedures in other disciplines — such as oncology, neurosurgery and orthopedics — that require patients to have pre-operative cardiac and vascular testing.

The cardiac MRI doesn’t eliminate all other pre-operative steps, such as blood work, and the procedure isn’t for those unable to tolerate the confinement of a closed MRI machine. Dr. Biederman said an open MRI machine isn’t an option because of the level of photographic detail required.

At 250 pounds, Mr. Vanfosson had to keep his arms raised to fit into the machine, which has a 55-centimeter bore. Dr. Biederman said the hospital is working to acquire a machine with a 70-centimeter bore.

Jim DiCiero, 76, of Rochester, Beaver County, said he was one of the first to undergo the new testing procedure before his liver transplant nearly four years ago. He said he decided to go through with the cardiac MRI even though he’s claustrophobic and kept himself calm by singing and otherwise distracting himself.

“I never opened my eyes the whole time,” he said.

Today, he said, he’s in good health and thankful for his transplant team. “I have more trouble with my aches and pains than I do with my transplant,” he said.


Joe Smydo