title: Performance of adenosine "stress-only" perfusion MRI in patients without a history of myocardial infarction: a clinical outcome study.
abstract: To assess the diagnostic value of adenosine "stress-only" myocardial perfusion MR for ischemia detection as an indicator for coronary angiography in patients without a prior myocardial infarction and a necessity to exclude ischemia. Adenosine perfusion MRI was performed at 1.5 T in 139 patients with a suspicion of ischemia and no prior myocardial infarction. After 3 min of adenosine infusion a perfusion sequence was started. Patients with a perfusion defect were referred to coronary angiography (CAG). Patients with a normal perfusion were enrolled in follow-up. Fourteen out of 139 patients (10.1%) had a perfusion defect indicative of ischemia. These patients underwent a coronary angiogram, which showed complete agreement with the perfusion images. 125 patients with a normal myocardial perfusion entered follow-up (median 672 days, range 333-1287 days). In the first year of follow-up one Major Adverse Coronary Event (MACE) occurred and one patient had new onset chest pain with a confirmed coronary stenosis. Reaching a negative predictive value for MACE of 99.2% and for any coronary event of 98.4%. At 2 year follow-up no additional MACE occurred. Sensitivity of adenosine perfusion MR for MACE is 93.3% and specificity and positive predictive value are 100%. Adenosine myocardial perfusion MR for the detection of myocardial ischemia in a "stress-only" protocol in patients without prior myocardial infarctions, has a high diagnostic accuracy. This fast examination can play an important role in the evaluation of patients without prior myocardial infarctions and a necessity to exclude ischemia.
authors.affiliation: Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. d.d.lubbers@rad.umcg.nl
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Lubbers
authors.forename: Dorine
authors.initials: D
authors.lastname: Rijlaarsdam-Hermsen
authors.forename: Dirkjan
authors.initials: D
authors.lastname: Kuijpers
authors.forename: Marjan
authors.initials: M
authors.lastname: Kerkhof
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sijens
authors.forename: Paul R M
authors.initials: PR
authors.lastname: van Dijkman
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
mesh_terms: D000241:Adenosine; D002637:Chest Pain / Q000150:complications; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000241:Adenosine