Imaging in Stem Cell Transplant and Cell-based Therapy

143

Although recent RCTs of cell therapy have largely utilized MRI, the above
evidence supports the applicability of all imaging techniques in a comparable fashion
in cell therapy trials. However, with regard to selection of imaging method(s), addi-
tional important factors need to be considered. Many trials cannot afford to use MRI
due to its relative lack of availability and higher cost. Furthermore, many patients who
enroll in these clinical trials have poor cardiac function resulting from complex cardiac
pathologies and may be clinically unstable. These patients may also have implantable

Table 9.3 Unadjusted differences in mean change in outcome parameters in bone marrow cell-
treated patients compared with controls based on the mode of imaging

Follow-up

duration

BMC

therapy (n)

Control

(n)

Difference in

mean [95% CI]

P Value for

Z

P Value for subgroup

differences

LVEF

    Echo 642 533 2.69 [1.27, 4.12] 0.0002 0.05

    SPECT 150 96 0.93 [−0.83,

2.68]

0.30

    MRI 642 533 1.60 [0.30, 2.90] 0.02

    LVG 372 305 5.26 [2.47, 8.05] 0.0002

Infarct size

    SPECT 155 135 −2.41 [−2.78,

−2.03]

<0.00001 0.19

    MRI 416 306 −1.18 [−2.97,

0.61]

0.20

LVESV

    Echo 249 195 −11.76

[−19.09, −4.43]

0.002 0.02

    SPECT 116 80 −4.57 [−11.13,

1.99]

0.17

    MRI 341 252 −2.59 [−3.90,

−1.27]

0.0001

    LVG 211 176 −11.12

[−19.27, −2.97]

0.008

LVEDV

    Echo 283 235 −2.41 [−2.79,

−2.03]

0.00001 0.42

    SPECT 116 80 −9.56 [−18.39,

−0.72]

0.03

    MRI 391 302 −1.48 [−6.21,

3.25]

0.54

    LVG 211 176 −0.31 [−10.47,

9.86]

0.95

Reproduced from Afzal et al. Circ Res 2015;117:558–575 with permission
Echo echocardiography, LVEDV left ventricular end-diastolic volume, LVEF left ventricular
ejection fraction, LVESV left ventricular end-systolic volume, LVG left ventriculography, MRI
magnetic resonance imaging, SPECT single-photon emission computed tomography, CI confi-
dence interval, n number of patients in each group

9 Bone Marrow Cell Therapy for Ischemic Heart Disease...