Combined myocardial stress perfusion imaging and myocardial stress tagging for detection of coronary artery disease at 3 Tesla.
BACKGROUND
Adenosine stress perfusion is very sensitive for detection of coronary artery disease (CAD), and yields good specificity. Standard adenosine cine imaging lacks high sensitivity, but is very specific. Myocardial tagging improves detection of wall motion abnormalities (WMAs). Perfusion and tagging cardiovascular magnetic resonance (CMR) both benefit from high field imaging (improved contrast to noise ratio and tag persistence). We investigated the diagnostic impact of a combined stress perfusion-tagging protocol for detection of CAD at 3 Tesla.


METHODS
Stress perfusion and tagging images were acquired in 3 identical short axis locations (slice thickness 8 mm, FOV 320-380 mm, matrix 256(2)). A positive finding at coronary angiography was defined as stenosis or flow limiting restenosis > 50% in native and graft vessels. A true positive CMR - finding was defined as > or = 1 perfusion deficit or new WMA during adenosine-stress in angiographically corresponding regions.


RESULTS
We included 60 patients (males: 41, females: 19; 21 suspected, 39 known CAD). Myocardial tagging extended stress imaging by 1.5-3 min and was well tolerated by all patients. Sensitivity and specificity for detection of significant CAD by adenosine stress perfusion were 0.93 and 0.84, respectively. The sensitivity of adenosine stress tagging was less (0.64), while the specificity was very high (1.0). The combination of both stress perfusion and stress tagging did not increase sensitivity.


CONCLUSIONS
The combined adenosine stress perfusion-tagging protocol delivers high sensitivity and specificity for detection of significant CAD. While the sensitivity of adenosine stress tagging is poor compared to perfusion imaging, its specificity is very high. This technique should thus prove useful in cases of inconclusive perfusion studies to help avoid false positive results.
Thomas
Daniel
D
Department of Radiology, University of Bonn, Bonn, Germany. daniel.thomas@ukb.uni-bonn.de
Strach
Katharina
K
Meyer
Carsten
C
Naehle
Claas P
CP
Schaare
Sebastian
S
Wasmann
Sven
S
Schild
Hans H
HH
Sommer
Torsten
T
D000241:Adenosine; D000328:Adult; D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D000241:Adenosine