title: Arterial spin labeled CMR detects clinically relevant increase in myocardial blood flow with vasodilation.
abstract: OBJECTIVE
  This study sought to determine whether arterial spin labeled (ASL) cardiac magnetic resonance (CMR) is capable of detecting clinically relevant increases in regional myocardial blood flow (MBF) with vasodilator stress testing in human myocardium.
  
  
  BACKGROUND
  Measurements of regional myocardial perfusion at rest and during vasodilatation are used to determine perfusion reserve, which indicates the presence and distribution of myocardial ischemia. ASL CMR is a perfusion imaging technique that does not require any contrast agents, and is therefore safe for use in patients with end-stage renal disease, and capable of repeated or continuous measurement.
  
  
  METHODS
  Myocardial ASL scans at rest and during adenosine infusion were incorporated into a routine CMR adenosine induced vasodilator stress protocol and was performed in 29 patients. Patients who were suspected of having ischemic heart disease based on first-pass imaging also underwent x-ray angiography. Myocardial ASL was performed using double-gated flow-sensitive alternating inversion recovery tagging and balanced steady-state free precession imaging at 3-T.
  
  
  RESULTS
  Sixteen patients were found to be normal and 13 patients were found to have visible perfusion defect based on first-pass CMR using intravenous gadolinium chelate. In the normal subjects, there was a statistically significant difference between MBF measured by ASL during adenosine infusion (3.67 ± 1.36 ml/g/min), compared to at rest (0.97 ± 0.64 ml/g/min), with p < 0.0001. There was also a statistically significant difference in perfusion reserve (MBF(stress)/MBF(rest)) between normal myocardial segments (3.18 ± 1.54) and the most ischemic segments in the patients with coronary artery disease identified by x-ray angiography (1.44 ± 0.97), with p = 0.0011.
  
  
  CONCLUSIONS
  This study indicates that myocardial ASL is capable of detecting clinically relevant increases in MBF with vasodilatation and has the potential to identify myocardial ischemia.
authors.affiliation: Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, USA.
authors.forename: Zungho
authors.initials: Z
authors.lastname: Zun
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
authors.forename: Eric C
authors.initials: EC
authors.lastname: Wong
authors.forename: Krishna S
authors.initials: KS
authors.lastname: Nayak
mesh_terms: D000241:Adenosine; D000368:Aged; D002140:California; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D013113:Spin Labels; D014664:Vasodilation; D014665:Vasodilator Agents
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D013113:Spin Labels; D014665:Vasodilator Agents; C064572:gadobenic acid; D008536:Meglumine; D000241:Adenosine