Diagnostic performance of myocardial perfusion MR at 3 T in patients with coronary artery disease.
OBJECTIVE
To prospectively determine the diagnostic performance of myocardial perfusion magnetic resonance (MR) imaging at 3 T for helping depict clinically relevant coronary artery stenosis (> or =50% diameter) in patients with suspected or known coronary artery disease (CAD), with coronary angiography as the reference standard.


METHODS
The study was approved by the local ethics committee; written informed consent was obtained. Vasodilator stress perfusion imaging by using a turbo field-echo sequence was obtained in 101 patients (71 men, 30 women; mean age, 62 years +/- 7.7 [standard deviation]) scheduled for coronary angiography. Myocardial ischemia was defined as stress-inducible perfusion deficit in arterial territories without delayed enhancement (DE) or additional stress-inducible perfusion deficit in territories with nontransmural DE. Images were evaluated in consensus by two blinded readers. Diagnostic performance was determined on per-patient and per-coronary artery territory bases. The number of dark rim artifacts in patients without DE was determined in a second read. Interobserver variability was assessed in 40 randomly selected patients.


RESULTS
One hundred one patients underwent MR examinations. Coronary angiography depicted relevant stenosis in 70 (69%) patients. Patient-based sensitivity and specificity were 90% and 71%, respectively. Sensitivity, specificity, and diagnostic accuracy for the detection of coronary stenosis in a specific territory were 76%, 89%, and 86%, respectively. In 24% of patients without DE, dark rim artifacts were detected, mostly in the left anterior descending artery territory (56%). In 40 randomly selected patients, there was agreement in the determination of myocardial perfusion deficits in 37 (93%, kappa = 0.79) patients.


CONCLUSIONS
Myocardial perfusion MR imaging by using saturation-recovery spoiled gradient-echo imaging at 3 T has an accuracy of 84% for depicting hemodynamically relevant coronary artery stenosis in patients with suspected and known CAD.
Gebker
Rolf
R
Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. gebker@dhzb.de
Jahnke
Cosima
C
Paetsch
Ingo
I
Kelle
Sebastian
S
Schnackenburg
Bernhard
B
Fleck
Eckart
E
Nagel
Eike
E
D016477:Artifacts; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA