title: Detection of myocardial ischemia by automated, motion-corrected, color-encoded perfusion maps compared with visual analysis of adenosine stress cardiovascular magnetic resonance imaging at 3 T: a pilot study.
abstract: OBJECTIVE
  The purpose of this study was to compare automated, motion-corrected, color-encoded (AMC) perfusion maps with qualitative visual analysis of adenosine stress cardiovascular magnetic resonance imaging for detection of flow-limiting stenoses.
  
  
  METHODS
  Myocardial perfusion measurements applying the standard adenosine stress imaging protocol and a saturation-recovery temporal generalized autocalibrating partially parallel acquisition (t-GRAPPA) turbo fast low angle shot (Turbo FLASH) magnetic resonance imaging sequence were performed in 25 patients using a 3.0-T MAGNETOM Skyra (Siemens Healthcare Sector, Erlangen, Germany). Perfusion studies were analyzed using AMC perfusion maps and qualitative visual analysis. Angiographically detected coronary artery (CA) stenoses greater than 75% or 50% or more with a myocardial perfusion reserve index less than 1.5 were considered as hemodynamically relevant. Diagnostic performance and time requirement for both methods were compared. Interobserver and intraobserver reliability were also assessed.
  
  
  RESULTS
  A total of 29 CA stenoses were included in the analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of ischemia on a per-patient basis were comparable using the AMC perfusion maps compared to visual analysis. On a per-CA territory basis, the attribution of an ischemia to the respective vessel was facilitated using the AMC perfusion maps. Interobserver and intraobserver reliability were better for the AMC perfusion maps (concordance correlation coefficient, 0.94 and 0.93, respectively) compared to visual analysis (concordance correlation coefficient, 0.73 and 0.79, respectively). In addition, in comparison to visual analysis, the AMC perfusion maps were able to significantly reduce analysis time from 7.7 (3.1) to 3.2 (1.9) minutes (P < 0.0001).
  
  
  CONCLUSIONS
  The AMC perfusion maps yielded a diagnostic performance on a per-patient and on a per-CA territory basis comparable with the visual analysis. Furthermore, this approach demonstrated higher interobserver and intraobserver reliability as well as a better time efficiency when compared to visual analysis.
authors.affiliation: First Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany. Christina.Doesch@umm.de
authors.forename: Christina
authors.initials: C
authors.lastname: Doesch
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
authors.forename: Henrik J
authors.initials: HJ
authors.lastname: Michaely
authors.forename: Ulrike I
authors.initials: UI
authors.lastname: Attenberger
authors.forename: Christopher
authors.initials: C
authors.lastname: Glielmi
authors.forename: Tim
authors.initials: T
authors.lastname: Süselbeck
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
mesh_terms: D000241:Adenosine; D000368:Aged; D016477:Artifacts; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D009038:Motion; D017202:Myocardial Ischemia / Q000175:diagnosis*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine