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The delay of contrast arrival in magnetic resonance first-pass perfusion imaging: A novel non-invasive parameter detecting collateral-dependent myocardium
  1. Olaf M Muehling (drmuehling{at}aol.com)
  1. University of Munich, Germany
    1. Armin Huber (ahuber{at}med.uni-muenchen.de)
    1. University of Munich, Germany
      1. Clemens Cyran
      1. University of Munich, Germany
        1. Stefan O Schoenberg
        1. University of Munich, Germany
          1. Maximilian Reiser
          1. University of Munich, Germany
            1. Gerhard Steinbeck
            1. University of Munich, Germany
              1. Michael Nabauer
              1. University of Munich, Germany
                1. Michael Jerosch-Herold
                1. Oregon Health and Science Institute, Portland USA, United States

                  Abstract

                  Objectives To establish the regional delay of contrast arrival in magnetic resonance perfusion imaging (MRPI) for the detection of collateral-dependent myocardium in patients with coronary artery disease.

                  Design and Setting Observational study, case series; single center, university hospital.

                  Patients 30 patients with coronary artery disease and collateral-dependent myocardium and 17 healthy volunteers.

                  Methods Resting and hyperemic (adenosine) MRPI was used to determine delay time (Δtd) of contrast arrival between the left ventricle and collateral-dependent or antegradely-perfused myocardium, and myocardial perfusion (MP, ml/g/min).

                  Results In healthy volunteers Δtd at rest and during hyperemia were 0.8±0.4 and 0.3±0.3 sec., and MP was 1.14±0.21 and 4.23±1.12 ml/min/g. Δtd in antegradely-perfused vs. collateral-dependent myocardium was 0.9±0.7 vs. 1.7±1.0 sec. at rest (p<0.001) and 0.4±0.3 vs. 1.1±0.6 sec (p<0.001) during hyperemia. MP was 1.12±0.11 and 0.98±0.28 ml/min/g (p = n.s.) at rest and 2.46±0.85 vs. 1.86±0.91 ml/min/g (p<0.01) during hyperemia. ROC analysis showed best sensitivity and specificity of 90% and 83% for hyperemic Δtd of >0.6 sec (AUC=0.89) to detect collateral-dependent myocardium, while resting Δtd (AUC= 0.77) or perfusion (AUC = 0.69 at rest or 0.70 during hyperemia) were less accurate.

                  Conclusions MRPI derived hyperemic delay of contrast arrival detects collateral-dependent myocardium with excellent sensitivity and specificity. Perfusion was less sensitive, emphasizing the clinical role of Δtd for non-invasive detection of collateral-dependent myocardium.

                  • collateral circulation
                  • magnetic resonance imaging
                  • perfusion

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