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Assessment of myocardial perfusion to detect coronary artery stenoses by steady-state-free-precession magnetic resonance first-pass imaging
  1. Nico Merkle
  1. University of Ulm, Germany
    1. Jochen Wohrle (jochen.woehrle{at}uniklinik-ulm.de)
    1. University of Ulm, Germany
      1. Olaf Grebe
      1. Ev. Krankenhaus Düsseldorf, Germany
        1. Thorsten Nusser
        1. University of Ulm, Germany
          1. Markus Kunze
          1. University of Ulm, Germany
            1. Hans A. Kestler
            1. University of Ulm, Germany
              1. Matthias Kochs
              1. University of Ulm, Germany
                1. Vinzenz Hombach
                1. University of Ulm, Germany

                  Abstract

                  Objective: To evaluate the diagnostic impact of magnetic resonance imaging (MRI) first-pass perfusion using a 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 catheterization labs.

                  Patients and methods: 228 patients were examined with coronary angiography and MRI (1.5T Intera CV). A 3-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 0.1mmol/kg body weight. Perfusion images were visually assessed. Analysis regarding myocardial hypoperfusion was done per patient and per vessel.

                  Results: Sensitivity, specificity and accuracy of MRI first-pass perfusion for detection of a coronary artery stenosis (>50% luminal narrowing) on a per patient basis was 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 LAD 91.4%, CX 81.6% and RCA 65.1% (p<0.001).

                  Conclusions: MRI fist-pass perfusion analysis using a SSFP sequence with three myocardial slices provides a high diagnostic impact regarding detection of coronary artery stenoses. This MRI technique can be included into daily practice with the potential to guide the indication for invasive coronary angiography.

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

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