title: Diagnostic performance of myocardial perfusion MR at 3 T in patients with coronary artery disease.
abstract: 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.
authors.affiliation: Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. gebker@dhzb.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
mesh_terms: 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
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA