CARDIAC IMAGING AND NON-INVASIVE TESTING

Assessment of myocardial perfusion for detection of coronary artery stenoses by steady-state, free-precession magnetic resonance first-pass imaging

Nico Merkle¹, Jochen Wöhrle¹, Olaf Grebe², Thorsten Nusser¹, Markus Kunze¹, Hans A Kestler³, Matthias Kochs¹, Vinzenz Hombach¹

¹ Department of Internal Medicine II, University of Ulm, Ulm, Germany
² Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
³ Bioinformatics, University of Ulm, Ulm, Germany

Dr J Wöhrle, Department of Internal Medicine II, University of Ulm, Robert-Koch-Strasse-8, 89081 Ulm, Germany; jochen.woehrle{at}uniklinik-ulm.de

Objective: To evaluate the diagnostic impact of magnetic resonance imaging (MRI) first-pass perfusion using steady-state, free-precession (SSFP) sequences with parallel imaging (SENSE) for detection of coronary stenoses.

Design: Prospective observational study.

Setting: University hospital, cardiac MRI and catheterisation laboratories.

Patients and methods: 228 patients were examined with coronary angiography and MRI (1.5 T Intera CV). A three-slice, short-axis SSFP perfusion scan with a saturation prepulse was performed during infusion of adenosine and at rest followed by myocardial scar (late enhancement) imaging. Gadolinium-DTPA was given at 0.1 mmol/kg body weight. Perfusion images were visually assessed. Analysis for myocardial hypoperfusion was done according to patient group and according to vessel.

Results: Sensitivity, specificity and accuracy of MRI first-pass perfusion for detection of a coronary artery stenosis (>50% luminal narrowing) in the total patient group were 93.0%, 85.7%, 91.2% and for a significant lesion (>70% luminal narrowing) 96.1%, 72.0%, 88.2%, respectively. Based on 536 coronary artery territories without myocardial scar, the sensitivity of MRI perfusion analysis for detection of a significant lesion was for the left anterior descending artery 91.4%, for the circumflex artery 81.6% and for the right coronary artery 65.1% (p<0.001).

Conclusions: MRI first-pass perfusion analysis using an SSFP sequence with three myocardial slices was a highly accurate diagnostic method for detection of coronary artery stenoses. This MRI technique can be included in daily practice and has the potential to guide the indication for invasive coronary angiography.

Abbreviations: CAD, coronary artery disease; CX, circumflex artery; LAD, left anterior descending artery; LE, late enhancement; NPV, negative predictive value; PPV, positive predictive value; RCA, right coronary artery; SNR, signal-to-noise ratio; SSFP, steady-state, free-precession

Keywords: magnetic resonance imaging; myocardial perfusion; coronary angiography; coronary stenosis; SSFP

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