title: Navigator-gated 3D blood oxygen level-dependent CMR at 3.0-T for detection of stress-induced myocardial ischemic reactions.
abstract: OBJECTIVE
  This study determined the value of navigator-gated 3-dimensional blood oxygen level-dependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions.
  
  
  BACKGROUND
  Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies.
  
  
  METHODS
  Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction > or =50%). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [DeltaSI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]).
  
  
  RESULTS
  The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90% and 84% of the patients, respectively. The DeltaSI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p < 0.001). The receiver-operator characteristic analysis identified a cutoff value of DeltaSI = 2.7% for the detection of coronary stenosis, resulting in a sensitivity and specificity of 85.0% and 80.5%, respectively. An MPRI cutoff value of 1.35 yielded a sensitivity and specificity of 89.5% and 85.8%, respectively. The DeltaSI significantly correlated with the degree of coronary stenosis (r = -0.65, p < 0.001). Additionally, DeltaSI and MPRI showed substantial agreement (kappa value 0.66).
  
  
  CONCLUSIONS
  Navigator-gated 3-dimensional BOLD imaging at 3.0-T reliably detected stress-induced myocardial ischemic reactions and may be considered a valid alternative to first-pass exogenous contrast-enhancement studies.
authors.affiliation: Department of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany. jahnke@dhzb.de
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D003287:Contrast Media; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000378:metabolism*; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA; D000241:Adenosine; D010100:Oxygen