Key result
X-ray phase contrast imaging of endomyocardial biopsies showed substantial agreement with classical histopathology (weighted kappa 0.80, p < 0.01) for identifying acute cellular rejection.
Why the study?
To evaluate the feasibility of synchrotron propagation-based X-ray phase contrast imaging for assessing acute cellular rejection and its agreement with classical histopathology in heart transplantation recipients.
Does synchrotron propagation-based X-ray phase contrast imaging (X-PCI) agree with classical histopathology in evaluating acute cellular rejection in endomyocardial biopsies from heart transplantation recipients?
Cross-Sectional (n=23)
Single-blind
No
Does synchrotron propagation-based X-ray phase contrast imaging (X-PCI) agree with classical histopathology in evaluating acute cellular rejection in endomyocardial biopsies from heart transplantation recipients?
Effect estimate: weighted kappa 0.80 (95% CI 0.43-1.16)
p-value: p=<0.01
X-ray phase contrast imaging provides a feasible, non-destructive 3D alternative that shows substantial agreement with classical histopathology for detecting acute cellular rejection in heart transplant biopsies.
Endomyocardial biopsies are the gold standard for surveillance of graft rejection following heart transplantation, and are assessed by classical histopathology using a limited number of previously stained slices from several biopsies. Synchrotron propagation-based X-ray phase contrast imaging is a non-destructive method to image biological samples without tissue preparation, enabling virtual 2D and 3D histopathology. We aimed to show the feasibility of this method to assess acute cellular rejection and its agreement to classical histopathology. Right ventricular biopsies were sampled from 23 heart transplantation recipients (20 males, mean age 54±14 years) as part of standard follow-up. The clinical diagnosis of potential rejection was made using classical histopathology. One additional study sample was harvested and imaged by X-ray phase contrast imaging, producing 3D datasets with 0.65 μm pixel size, and up to 4,320 images per sample. An experienced pathologist graded both histopathological and X-ray phase contrast images in a blinded fashion. The agreement between methods was assessed by weighted kappa, showing substantial agreement (kappa up to 0.80, p < 0.01) between X-ray phase contrast imaging and classical histopathology. X-ray phase contrast imaging does not require tissue processing, allows thorough analysis of a full myocardial sample and allows identification of acute cellular rejection.
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Planinc et al. (2023) conducted a cross-sectional in Acute cellular rejection after heart transplantation (n=23). X-ray Phase Contrast Imaging (X-PCI) vs. Classical histopathology was evaluated on Agreement between X-PCI 2D virtual histopathology and clinical histopathological diagnosis for acute cellular rejection grading (weighted kappa 0.80, 95% CI 0.43-1.16, p=<0.01). X-ray phase contrast imaging of endomyocardial biopsies showed substantial agreement with classical histopathology (weighted kappa 0.80, p < 0.01) for identifying acute cellular rejection.
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