Myocardial first-pass perfusion magnetic resonance imaging: a multicenter dose-ranging study.
BACKGROUND
MRI can identify patients with obstructive coronary artery disease by imaging the left ventricular myocardium during a first-pass contrast bolus in the presence and absence of pharmacologically induced myocardial hyperemia. The purpose of this multicenter dose-ranging study was to determine the minimally efficacious dose of gadopentetate dimeglumine injection (Magnevist Injection; Berlex Laboratories) for detecting obstructive coronary artery disease.


RESULTS
A total of 99 patients scheduled for coronary artery catheterization as part of their clinical evaluation were enrolled in this study. Patients were randomized to 1 of 3 doses of gadopentate dimeglumine: 0.05, 0.10, or 0.15 mmol/kg. First-pass perfusion imaging was performed during hyperemia (induced by a 4-minute infusion of adenosine at a rate of 140 microg x kg(-1) x min(-1)) and then again in the absence of adenosine with otherwise identical imaging parameters and the same contrast dose. Perfusion defects were evaluated subjectively by 4 blinded reviewers. Receiver-operating curve analysis showed that the areas under the receiver-operating curve were 0.90, 0.72, and 0.83 for the low-, medium-, and high-contrast doses, respectively, compared with quantitative coronary angiography (diameter stenosis > or =70%). For the low-dose group, mean sensitivity was 93+/-0%, mean specificity was 75+/-7%, and mean accuracy was 85+/-3%.


CONCLUSIONS
First-pass perfusion MRI is a safe and accurate test for identifying patients with obstructive coronary artery disease. A low dose of 0.05 mmol/kg gadopentetate dimeglumine is at least as efficacious as higher doses.
Wolff
S D
SD
Cardiovascular Research Foundation and Lenox Hill Hospital, New York, NY, USA. swolff@mrict.com
Schwitter
J
J
Coulden
R
R
Friedrich
M G
MG
Bluemke
D A
DA
Biederman
R W
RW
Martin
E T
ET
Lansky
A J
AJ
Kashanian
F
F
Foo
T K F
TK
Licato
P E
PE
Comeau
C R
CR
D000241:Adenosine; D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D005189:False Positive Reactions; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
D003287:Contrast Media; D019786:Gadolinium DTPA; D000241:Adenosine