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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
  1. Nico Merkle1,
  2. Jochen Wöhrle1,
  3. Olaf Grebe2,
  4. Thorsten Nusser1,
  5. Markus Kunze1,
  6. Hans A Kestler3,
  7. Matthias Kochs1,
  8. Vinzenz Hombach1
  1. 1
    Department of Internal Medicine II, University of Ulm, Ulm, Germany
  2. 2
    Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
  3. 3
    Bioinformatics, University of Ulm, Ulm, Germany
  1. Dr J Wöhrle, Department of Internal Medicine II, University of Ulm, Robert-Koch-Strasse-8, 89081 Ulm, Germany; jochen.woehrle{at}uniklinik-ulm.de

Abstract

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.

  • magnetic resonance imaging
  • myocardial perfusion
  • coronary angiography
  • coronary stenosis
  • SSFP

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Footnotes

  • Conflict of interest: None declared.

  • Nico Merkle and Jochen Wöhrle contributed equally—both should be considered first authors.

  • 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

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