title: An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion.
abstract: BACKGROUND
  To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo-echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.
  
  
  METHODS
  Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.
  
  
  RESULTS
  Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).
  
  
  CONCLUSIONS
  GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.
authors.affiliation: Department of Radiology, Ryhov County Hospital, Jonkoping, Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Ahlander
authors.affiliation: Department of Radiology, Ryhov County Hospital, Jonkoping, Sweden.|Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Maret
authors.affiliation: Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Brudin
authors.affiliation: Department of Natural Science and Biomedicine, School of Health Sciences, Jonkoping University, Jonkoping, Sweden.|Department of Oncology, Hospital Physics, Ryhov County Hospital, Jonkoping, Sweden.
authors.forename: Sven-Ake
authors.initials: SA
authors.lastname: Starck
authors.affiliation: Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.|Department of Clinical Physiology, County Council of Ostergotland, Linkoping, Sweden.|Center of Medical Image Science and Visualisation, Linkoping University, Linkoping, Sweden.
authors.forename: Jan
authors.identifier: http://orcid.org/0000-0002-5716-5098
authors.initials: J
authors.lastname: Engvall
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014796:Visual Perception
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D019786:Gadolinium DTPA; D000241:Adenosine
keywords: Magnetic Resonance Imaging; cardiac imaging techniques; coronary heart disease; nuclear medicine; perfusion