title: High-resolution magnetic resonance myocardial perfusion imaging at 3.0-Tesla to detect hemodynamically significant coronary stenoses as determined by fractional flow reserve.
abstract: OBJECTIVE
  The objective of this study was to compare visual and quantitative analysis of high spatial resolution cardiac magnetic resonance (CMR) perfusion at 3.0-T against invasively determined fractional flow reserve (FFR).
  
  
  BACKGROUND
  High spatial resolution CMR myocardial perfusion imaging for the detection of coronary artery disease (CAD) has recently been proposed but requires further clinical validation.
  
  
  METHODS
  Forty-two patients (33 men, age 57.4 ± 9.6 years) with known or suspected CAD underwent rest and adenosine-stress k-space and time sensitivity encoding accelerated perfusion CMR at 3.0-T achieving in-plane spatial resolution of 1.2 × 1.2 mm(2). The FFR was measured in all vessels with >50% severity stenosis. Fractional flow reserve <0.75 was considered hemodynamically significant. Two blinded observers visually interpreted the CMR data. Separately, myocardial perfusion reserve (MPR) was estimated using Fermi-constrained deconvolution.
  
  
  RESULTS
  Of 126 coronary vessels, 52 underwent pressure wire assessment. Of these, 27 lesions had an FFR <0.75. Sensitivity and specificity of visual CMR analysis to detect stenoses at a threshold of FFR <0.75 were 0.82 and 0.94 (p < 0.0001), respectively, with an area under the receiver-operator characteristic curve of 0.92 (p < 0.0001). From quantitative analysis, the optimum MPR to detect such lesions was 1.58, with a sensitivity of 0.80, specificity of 0.89 (p < 0.0001), and area under the curve of 0.89 (p < 0.0001).
  
  
  CONCLUSIONS
  High-resolution CMR MPR at 3.0-T can be used to detect flow-limiting CAD as defined by FFR, using both visual and quantitative analyses.
authors.affiliation: Cardiovascular Division, King's College London BHF Centre of Excellence, and NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Lockie
authors.forename: Masaki
authors.initials: M
authors.lastname: Ishida
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Kalpa
authors.initials: K
authors.lastname: De Silva
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kozerke
authors.forename: Mike
authors.initials: M
authors.lastname: Marber
authors.forename: Eike
authors.initials: E
authors.lastname: Nagel
authors.forename: Reza
authors.initials: R
authors.lastname: Rezavi
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
mesh_terms: D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index