title: Rapid ungated myocardial perfusion cardiovascular magnetic resonance: preliminary diagnostic accuracy.
abstract: BACKGROUND
  Myocardial perfusion cardiovascular magnetic resonance (CMR) is a well-established method for detection of ischemic heart disease. However, ECG gating problems can result in image degradation and non-diagnostic scans, particularly in patients with arrhythmias.
  
  
  METHODS
  A turboFLASH saturation recovery pulse sequence was used without any ECG triggering. One saturation pulse followed by 4-5 slices of undersampled radial k-space images was acquired rapidly, on the order of 40-50 msec per image. The acquisition of the set of 4-5 slices was continuously repeated approximately 4 times per second. An iterative constrained reconstruction method was used to reconstruct the ungated images. The ungated perfusion images were post-processed into three different sets of images (ungated, self-gated to near systole, and self-gated to near diastole). To test the ungated approach and compare the different processing methods, 8 patients scheduled for coronary angiography underwent stress and rest perfusion imaging with the ungated acquisition. Six patients had a history of atrial fibrillation (AF). Three blinded readers assessed image quality and presence/absence of disease.
  
  
  RESULTS
  All 8 subjects successfully completed the perfusion CMR protocol and 7/8 underwent coronary angiography. Three patients were in atrial fibrillation during CMR. Overall, the CMR images were of high quality as assessed by the three readers. There was little difference in image quality between patients in AF compared to those in sinus rhythm (3.6±0.7 vs. 3.3±0.5). Stress/rest perfusion imaging showed normal perfusion in 4 patients, fixed perfusion defects in 2 patients, and reversible perfusion defects in 2 patients, corresponding with angiographic results. Pooled results from the independent readers gave a sensitivity of 0.92 (CI 0.65-0.99) and specificity of 0.92 (CI 0.65-0.99) for the detection of coronary artery disease using ungated perfusion imaging. The same sensitivity, and a specificity of 1 (CI 0.76-1), was achieved when the images were self-gated after acquisition into near systole or near diastole.
  
  
  CONCLUSIONS
  Ungated radial dynamic perfusion CMR can give high quality imaging in patients in sinus rhythm and during atrial fibrillation. In this small cohort, high diagnostic accuracy was possible with this rapid perfusion imaging sequence. An ungated approach simplifies the acquisition and could expand the role of perfusion CMR to include patients with arrhythmia and those with gating problems.
authors.forename: Alexis
authors.initials: A
authors.lastname: Harrison
authors.forename: Ganesh
authors.initials: G
authors.lastname: Adluru
authors.forename: Kavitha
authors.initials: K
authors.lastname: Damal
authors.forename: Akram M
authors.initials: AM
authors.lastname: Shaaban
authors.forename: Brent
authors.initials: B
authors.lastname: Wilson
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Chris
authors.initials: C
authors.lastname: McGann
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: Edward V R
authors.initials: EV
authors.lastname: DiBella
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D055424:Cardiac-Gated Imaging Techniques; D016022:Case-Control Studies; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D003287:Contrast Media
references.citation: J Magn Reson Imaging. 2009 Feb;29(2):466-73
references.pmid: 19161204
references.citation: Magn Reson Med. 2008 Sep;60(3):683-90
references.pmid: 18727084
references.citation: Europace. 2010 May;12(5):643-8
references.pmid: 20022875
references.citation: PLoS One. 2011;6(9):e24964
references.pmid: 21957469
references.citation: J Magn Reson Imaging. 2006 Nov;24(5):1062-70
references.pmid: 17031818
references.citation: Magn Reson Med. 2004 Aug;52(2):354-61
references.pmid: 15282818
references.citation: J Cardiovasc Magn Reson. 2003 Jul;5(3):475-85
references.pmid: 12882078
references.citation: Circulation. 2003 Jul 29;108(4):432-7
references.pmid: 12860910
references.citation: Eur Heart J. 2013 Mar;34(10):775-81
references.pmid: 22390914
references.citation: Magn Reson Med. 2013 Aug;70(2):504-16
references.pmid: 22899104
references.citation: J Cardiovasc Magn Reson. 2010 May 19;12:29
references.pmid: 20482819
references.citation: Radiology. 2008 Apr;247(1):57-63
references.pmid: 18305188
references.citation: Magn Reson Med. 2004 Jan;51(1):93-102
references.pmid: 14705049
references.citation: Prog Cardiovasc Dis. 2011 Nov-Dec;54(3):191-203
references.pmid: 22014487
references.citation: Am J Cardiol. 2008 Jan 1;101(1):8-14
references.pmid: 18157957
references.citation: Lancet. 2012 Feb 4;379(9814):453-60
references.pmid: 22196944
references.citation: Magn Reson Med. 2005 Jan;53(1):159-68
references.pmid: 15690515
references.citation: Magn Reson Med. 2012 Mar;67(3):609-13
references.pmid: 22190332
references.citation: Radiology. 2005 May;235(2):423-30
references.pmid: 15858084
references.citation: Magn Reson Med. 2004 Oct;52(4):782-8
references.pmid: 15389958
references.citation: Heart. 2007 Nov;93(11):1381-5
references.pmid: 17488772
references.citation: Radiology. 2012 Mar;262(3):816-23
references.pmid: 22357884
references.citation: Circulation. 2011 Mar 1;123(8):933-44
references.pmid: 21262990
references.citation: Eur Heart J. 2004 Sep;25(18):1657-65
references.pmid: 15351166
references.citation: Eur Heart J. 2008 Feb;29(4):480-9
references.pmid: 18208849
references.citation: Magn Reson Med. 2010 May;63(5):1230-7
references.pmid: 20432294
references.citation: Magn Reson Med. 2005 Nov;54(5):1295-9
references.pmid: 16200553
references.citation: Radiology. 2003 Oct;229(1):209-16
references.pmid: 12944596
references.citation: Circulation. 2012 Jan 3;125(1):188-97
references.pmid: 22215894