- 作者：Cosima Jahnke ; MD?/sup> ; jahnke@dhzb.de ; Rolf Gebker ; MD?/sup> ; Robert Manka ; MD?/sup> ; Bernhard Schnackenburg ; PhD&dagger ; ; Eckart Fleck ; MD?/sup> ; Ingo Paetsch ; MD?/sup>
- 关键词：cardiac magnetic resonance ; blood oxygen level&ndash ; dependent ; first-pass perfusion imaging ; adenosine stress
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2010
- 出版时间：April 2010
- 年：2010
- 卷：3
- 期：4
- 页码：375-384
- 全文大小：587 K
Objectives
This study determined the value of navigator-gated 3-dimensional blood oxygen level¨Cdependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions.Background
Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies.
Methods
Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction ?0 % ). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [¦¤SI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]).
Results
The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90 % and 84 % of the patients, respectively. The ¦¤SI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p < 0.001). The receiver-operator characteristic analysis identified a cutoff value of ¦¤SI = 2.7 % for the detection of coronary stenosis, resulting in a sensitivity and specificity of 85.0 % and 80.5 % , respectively. An MPRI cutoff value of 1.35 yielded a sensitivity and specificity of 89.5 % and 85.8 % , respectively. The ¦¤SI significantly correlated with the degree of coronary stenosis (r = ?.65, p < 0.001). Additionally, ¦¤SI and MPRI showed substantial agreement (kappa value 0.66).
Conclusions
Navigator-gated 3-dimensional BOLD imaging at 3.0-T reliably detected stress-induced myocardial ischemic reactions and may be considered a valid alternative to first-pass exogenous contrast-enhancement studies.