Dynamic 3-dimensional stress cardiac magnetic resonance perfusion imaging: detection of coronary artery disease and volumetry of myocardial hypoenhancement before and after coronary stenting.
OBJECTIVE
The aim of this study was to establish a new, dynamic 3-dimensional cardiac magnetic resonance (3D-CMR) perfusion scan technique exploiting data correlation in k-space and time with sensitivity-encoding and to determine its value for the detection of coronary artery disease (CAD) and volumetry of myocardial hypoenhancement (VOLUME(hypo)) before and after percutaneous coronary stenting.


BACKGROUND
Dynamic 3D-CMR perfusion imaging might improve detection of myocardial perfusion deficits and could facilitate direct volumetry of myocardial hypoenhancement.


METHODS
In 146 patients with known or suspected CAD, a 3.0-T CMR examination was performed including cine imaging, 3D-CMR perfusion under adenosine stress and at rest followed by delayed enhancement imaging. Quantitative invasive coronary angiography defined significant CAD (≥ 50% luminal narrowing). Forty-eight patients underwent an identical repeat CMR examination after percutaneous stenting of at least 1 coronary lesion. The 3D-CMR perfusion scans were visually classified as pathologic if ≥ 1 segment showed an inducible perfusion deficit in the absence of delayed enhancement. The VOLUME(hypo) was measured by segmentation of the area of inducible hypoenhancement and normalized to left-ventricular myocardial volume (%VOLUME(hypo)).


RESULTS
The 3D-CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 91.7%, 74.3%, and 82.9%, respectively. Before and after coronary stenting, %VOLUME(hypo) averaged to 14.2 ± 9.5% and 3.2 ± 5.2%, respectively, with a relative VOLUME(hypo) reduction of 79.4 ± 25.4%. Intrareader and inter-reader reproducibility of VOLUME(hypo) measurements was high (Lin's concordance correlation coefficient, 0.96 and 0.96, respectively).


CONCLUSIONS
The 3D-CMR stress perfusion provided high image quality and high diagnostic accuracy for the detection of significant CAD. The VOLUME(hypo) measurements were highly reproducible and allowed for the assessment of the treatment effect achievable by percutaneous coronary stenting.
Department of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany.
Robert
R
Manka
Cosima
C
Jahnke
Sebastian
S
Kozerke
Viton
V
Vitanis
Gerard
G
Crelier
Rolf
R
Gebker
Bernhard
B
Schnackenburg
Peter
P
Boesiger
Eckart
E
Fleck
Ingo
I
Paetsch
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000628:therapy*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis