Whole-heart dynamic three-dimensional magnetic resonance perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve: determination of volumetric myocardial ischaemic burden and coronary lesion location.
OBJECTIVE
Dynamic three-dimensional-cardiac magnetic resonance (3D-CMR) perfusion proved highly diagnostic for the detection of angiographically defined coronary artery disease (CAD) and has been used to assess the efficacy of coronary stenting procedures. The present study aimed to relate significant coronary lesions as assessed by fractional flow reserve (FFR) to the volume of myocardial hypoenhancement on 3D-CMR adenosine stress perfusion imaging and to define the inter-study reproducibility of stress inducible 3D-CMR hypoperfusion.


RESULTS
A total of 120 patients with known or suspected CAD were examined in two CMR centres using 1.5 T systems. The protocol included cine imaging, 3D-CMR perfusion during adenosine infusion, and at rest followed by delayed enhancement (DE) imaging. Fractional flow reserve was recorded in epicardial coronary arteries and side branches with ≥2 mm luminal diameter and >40% severity stenosis (pathologic FFR < 0.75). Twenty-five patients underwent an identical repeat CMR examination for the determination of inter-study reproducibility of 3D-CMR perfusion deficits induced by adenosine. Three-dimensional CMR perfusion scans were visually classified as pathologic if one or more segments showed an inducible perfusion deficit in the absence of DE. Myocardial ischaemic burden (MIB) was measured by segmentation of the area of inducible hypoenhancement and normalized to left ventricular myocardial volume (MIB, %). Three-dimensional CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 90, 82, and 87%, respectively. Substantial concordance was found for inter-study reproducibility [Lin's correlation coefficient: 0.98 (95% confidence interval: 0.96-0.99)].


CONCLUSIONS
Three-dimensional CMR stress perfusion provided high diagnostic accuracy for the detection of functionally significant CAD. Myocardial ischaemic burden measurements were highly reproducible and allowed the assessment of CAD severity.
Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland. robert.manka@usz.ch
Robert
R
Manka
Ingo
I
Paetsch
Sebastian
S
Kozerke
Marco
M
Moccetti
Rainer
R
Hoffmann
Joerg
J
Schroeder
Sebastian
S
Reith
Bernhard
B
Schnackenburg
Oliver
O
Gaemperli
Lukas
L
Wissmann
Christophe A
CA
Wyss
Philipp A
PA
Kaufmann
Roberto
R
Corti
Peter
P
Boesiger
Nikolaus
N
Marx
Thomas F
TF
Lüscher
Cosima
C
Jahnke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity