Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease.
BACKGROUND
With MRI, an index of myocardial perfusion reserve (MPRI) can be determined. We assessed the value of this technique for the noninvasive detection of coronary artery disease (CAD) in patients with suspected CAD.


RESULTS
Eighty-four patients referred for a primary diagnostic coronary angiography were examined with a 1.5 T MRI tomograph (Philips-ACS). For each heartbeat, 5 slices were acquired during the first pass of 0.025 mmol gadolinium-diethylenetriamine pentaacetic acid/kg body weight before and during adenosine vasodilation by using a turbo-gradient echo/echo-planar imaging-hybrid sequence. MPRI was determined from the alteration of the upslope of the myocardial signal intensity curves for 6 equiangular segments per slice. Receiver operating characteristics were performed for different criteria to differentiate ischemic and nonischemic segments. Prevalence of CAD was 51%. Best results were achieved when only the 3 inner slices were assessed and a threshold value of 1.1 was used for the second smallest value as a marker for significant CAD. This approach yielded a sensitivity of 88%, specificity of 90%, and accuracy of 89%.


CONCLUSIONS
The determination of MPRI with MRI yields a high diagnostic accuracy in patients with suspected CAD.
Nagel
Eike
E
Cardiology, German Heart Institute, Augustenburger Platz 1, 13353 Berlin, Germany. eike.nagel@dhzb.de
Klein
Christoph
C
Paetsch
Ingo
I
Hettwer
Sabine
S
Schnackenburg
Bernhard
B
Wegscheider
Karl
K
Fleck
Eckart
E
D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D017352:Echo-Planar Imaging; D005260:Female; D019786:Gadolinium DTPA; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D019786:Gadolinium DTPA