title: Is the diagnostic yield of myocardial stress perfusion MRI impaired by three-vessel coronary artery disease?
abstract: BACKGROUND
  Three-vessel coronary artery disease (CAD) comes along with globally reduced myocardial perfusion potentially restricting the demarcation of regional hypoperfusion in stress perfusion cardiac magnetic resonance imaging (MRI).
  
  
  OBJECTIVE
  To evaluate whether stress perfusion cardiac MRI is capable of detecting myocardial hypoperfusion in patients with 3-vessel CAD reliably.
  
  
  METHODS
  Two hundred and five patients with symptoms of CAD were included. The examination protocol comprised imaging of myocardial perfusion at stress (0.14 mg/kg/min adenosine for 4 min) using a 2D saturation recovery gradient echo sequence after administration of gadobutrol (0.1 mmol/kg body weight). Perfusion sequences were assessed qualitatively by two experienced observers. Coronary angiography served as standard of reference.
  
  
  RESULTS
  Sensitivity and specificity for hemodynamically relevant stenoses in patients with 0-, 1-, 2-, 3-vessel coronary artery disease were 100%/91%, 91%/73%, 90%/71%, 92%/64%; positive/negative predictive value, 67%/100%, 91%/73%, 83%/81%, 93%/58%; diagnostic accuracy, 93%/87%/83%/87%, respectively. The negative predictive value in patients with 3-vessel CAD was lower than in patients with 0- and 2-vessel CAD and the specificity lower than in patients with no CAD whereas the positive predictive value was higher than in patients with no CAD. The other proportions did not differ significantly between the groups.
  
  
  CONCLUSIONS
  The diagnostic value of stress perfusion cardiac MRI in patients with 3-vessel CAD is comparable to results in patients with 1- or 2-vessel CAD. In the rare event that stress perfusion images do not depict regional hypoperfusion in patients with severe 3-vessel CAD, myocardial ischemia could be identified by reduced semi-quantitative perfusion parameters.
authors: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany bernhard.klumpp@med.uni-tuebingen.de.
authors: Bernhard
authors: B
authors: Klumpp
authors: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany.
authors: S
authors: S
authors: Miller
authors: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany.
authors: A
authors: A
authors: Seeger
authors: Department of Cardiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors: A E
authors: AE
authors: May
authors: Department of Cardiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
authors: M P
authors: MP
authors: Gawaz
authors: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany.
authors: C D
authors: CD
authors: Claussen
authors: Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University-Tuebingen, Tuebingen, Germany.
authors: U
authors: U
authors: Kramer
mesh_terms: D016477:Artifacts; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Cardiac magnetic resonance imaging (MRI); arteriosclerosis; infarction; ischemia; myocardial MR perfusion