title: Assessment of advanced coronary artery disease: advantages of quantitative cardiac magnetic resonance perfusion analysis.
abstract: OBJECTIVE
  The purpose of this paper was to compare quantitative cardiac magnetic resonance (CMR) first-pass contrast-enhanced perfusion imaging to qualitative interpretation for determining the presence and severity of coronary artery disease (CAD).
  
  
  BACKGROUND
  Adenosine CMR can detect CAD by measuring perfusion reserve (PR) or by qualitative interpretation (QI).
  
  
  METHODS
  Forty-one patients with an abnormal nuclear stress scheduled for X-ray angiography underwent dual-bolus adenosine CMR. Segmental myocardial perfusion analyzed using both QI and PR by Fermi function deconvolution was compared to quantitative coronary angiography.
  
  
  RESULTS
  In the 30 patients with complete quantitative data, PR (mean +/- SD) decreased stepwise as coronary artery stenosis (CAS) severity increased: 2.42 +/- 0.94 for <50%, 2.14 +/- 0.87 for 50% to 70%, and 1.85 +/- 0.77 for >70% (p < 0.001). The PR and QI had similar diagnostic accuracies for detection of CAS >50% (83% vs. 80%), and CAS >70% (77% vs. 67%). Agreement between observers was higher for quantitative analysis than for qualitative analysis. Using PR, patients with triple-vessel CAD had a higher burden of detectable ischemia than patients with single-vessel CAD (60% vs. 25%; p = 0.02), whereas no difference was detected by QI (31% vs. 21%; p = 0.26). In segments with myocardial scar (n = 64), PR was 3.10 +/- 1.34 for patients with CAS <50% (n = 18) and 1.91 +/- 0.96 for CAS >50% (p < 0.0001).
  
  
  CONCLUSIONS
  Quantitative PR by CMR differentiates moderate from severe stenoses in patients with known or suspected CAD. The PR analysis differentiates triple- from single-vessel CAD, whereas QI does not, and determines the severity of CAS subtending myocardial scar. This has important implications for assessment of prognosis and therapeutic decision making.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois, USA.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Antkowiak
authors.forename: Kiran R
authors.initials: KR
authors.lastname: Nandalur
authors.forename: Amy M
authors.initials: AM
authors.lastname: West
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
authors.forename: Vishal
authors.initials: V
authors.lastname: Arora
authors.forename: John
authors.initials: J
authors.lastname: Christopher
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Epstein
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
mesh_terms: D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D012720:Severity of Illness Index
chemical_list: D000241:Adenosine