Dynamic 3-Dimensional Stress Cardiac Magnetic Resonance Perfusion Imaging: Detection of Coronary Artery Disease and Volumetry of Myocardial Hypoenhancement Before and After Coronary Stenting

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• 作者：Robert Manka MD ; ^† ; ; Cosima Jahnke MD ; Sebastian Kozerke PhD^† ; ; Viton Vitanis MSc^† ; ; Gerard Crelier PhD^† ; ; Rolf Gebker MD ; Bernhard Schnackenburg PhD ; Peter Boesiger PhD^† ; ; Eckart Fleck MD ; Ingo Paetsch MD ; ^{ipaetsch@ukaachen.de}
• 关键词：3-dimensional cardiac MR perfusion ; adenosine stress ; magnetic resonance imaging ; volumetry of myocardial hypoenhancement
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：25 January 2011
• 年：2011
• 卷：57
• 期：4
• 页码：437-444
• 全文大小：1874 K

文摘

Objectives

The aim of this study was to establish a new, dynamic 3-dimensional cardiac magnetic resonance (3D-CMR) perfusion scan technique exploiting data correlation in k-space and time with sensitivity-encoding and to determine its value for the detection of coronary artery disease (CAD) and volumetry of myocardial hypoenhancement (VOLUME_hypo) before and after percutaneous coronary stenting.

Background

Dynamic 3D-CMR perfusion imaging might improve detection of myocardial perfusion deficits and could facilitate direct volumetry of myocardial hypoenhancement.

Methods

In 146 patients with known or suspected CAD, a 3.0-T CMR examination was performed including cine imaging, 3D-CMR perfusion under adenosine stress and at rest followed by delayed enhancement imaging. Quantitative invasive coronary angiography defined significant CAD (≥50 % luminal narrowing). Forty-eight patients underwent an identical repeat CMR examination after percutaneous stenting of at least 1 coronary lesion. The 3D-CMR perfusion scans were visually classified as pathologic if ≥1 segment showed an inducible perfusion deficit in the absence of delayed enhancement. The VOLUME_hypo was measured by segmentation of the area of inducible hypoenhancement and normalized to left-ventricular myocardial volume ( % VOLUME_hypo).

Results

The 3D-CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 91.7 % , 74.3 % , and 82.9 % , respectively. Before and after coronary stenting, % VOLUME_hypo averaged to 14.2 ± 9.5 % and 3.2 ± 5.2 % , respectively, with a relative VOLUME_hypo reduction of 79.4 ± 25.4 % . Intrareader and inter-reader reproducibility of VOLUME_hypo measurements was high (Lin's concordance correlation coefficient, 0.96 and 0.96, respectively).

Conclusions

The 3D-CMR stress perfusion provided high image quality and high diagnostic accuracy for the detection of significant CAD. The VOLUME_hypo measurements were highly reproducible and allowed for the assessment of the treatment effect achievable by percutaneous coronary stenting.