title: Myocardial perfusion cardiac magnetic resonance for the diagnosis of coronary artery disease: do we need rest images?
abstract: Adenosine stress cardiovascular magnetic resonance (CMR) has been reported to be useful for the diagnosis of coronary artery disease (CAD). Most studies use rest and stress perfusion images. The objectives of this study were to determine (Barkhausen et al. in J Magn Reson Imaging 19(6):750-757, 1) the accuracy of visual assessment and myocardial perfusion reserve index (MPRI) in the diagnosis of CAD and (Rieber et al. in Fur Heart J 27(12):1465-1471, 2) the accuracy of analysis based on rest-stress and stress images. We enrolled patients with suspected CAD and referred them for coronary angiography (CAG). All the patients underwent adenosine stress CMR before CAG. Rest and stress perfusion images were analyzed by calculation of MPRI and visual assessment separately. Visual assessment was performed separately by using rest and stress images and by using only stress images. CAG was considered the gold standard. Sensitivity, specificity, and accuracy of both methods were calculated and compared. A total of 66 patients (mean age, 61.3 +/- 11.7 years) were studied. Thirty-eight patients (57.6%) were diagnosed with CAD. The sensitivity and specificity for the diagnosis of CAD (> or =50% stenosis) were 89.5 and 78.6% for MPRI, 76.3 and 75% for stress-rest visual method, and 86.8 and 75% for stress visual method, respectively. CMR perfusion had a relatively lower accuracy in patients with left ventricular systolic dysfunction, high left ventricular mass, or presence of late gadolinium enhancement than in patients without those CMR findings. Visual assessment of stress image of CMR perfusion is accurate and comparable to MPRI for the detection of CAD.
authors.affiliation: Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. sirkt@mahidol.ac.th
authors.forename: Rungroj
authors.initials: R
authors.lastname: Krittayaphong
authors.forename: Thananya
authors.initials: T
authors.lastname: Boonyasirinant
authors.forename: Pairash
authors.initials: P
authors.lastname: Saiviroonporn
authors.forename: Supaporn
authors.initials: S
authors.lastname: Nakyen
authors.forename: Prajak
authors.initials: P
authors.lastname: Thanapiboonpol
authors.forename: Ahthit
authors.initials: A
authors.lastname: Yindeengam
authors.forename: Suthipol
authors.initials: S
authors.lastname: Udompunturak
mesh_terms: D000241:Adenosine; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left
chemical_list: D000241:Adenosine