title: Qualitative and semi-quantitative evaluation of myocardium perfusion with 3 T stress cardiac MRI.
abstract: BACKGROUND
  3 T MRI has been adopted by some centers as the primary choice for assessment of myocardial perfusion over conventional 1.5 T MRI. However, there is no data published on the potential additional value of incorporating semi-quantitative data from 3 T MRI. This study sought to determine the performance of qualitative 3 T stress magnetic resonance myocardial perfusion imaging (3 T-MRMPI) and the potential incremental benefit of using a semi-quantitative perfusion technique in patients with suspected coronary artery disease (CAD).
  
  
  METHODS
  Fifty eight patients (41 men; mean age: 59 years) referred for elective diagnostic angiography underwent stress 3 T MRMPI with a 32-channel cardiac receiver coil. The MR protocol included gadolinium-enhanced stress first-pass perfusion (0.56 mg/kg, dipyridamole), rest perfusion, and delayed enhancement (DE). Visual analysis was performed in two steps. Ischemia was defined as a territory with perfusion defect at stress study but no DE or a territory with DE but additional peri-infarcted perfusion defect at stress study. Semi-quantitative analysis was calculated by using the upslope of the signal intensity-time curve during the first pass of contrast medium during dipyridamole stress and at rest. ROC analysis was used to determine the MPRI threshold that maximized sensitivity. Quantitative coronary angiography served as the reference standard with significant stenosis defined as >70 % diameter stenosis. Diagnostic performance was determined on a per-patient and per-vessel basis.
  
  
  RESULTS
  Qualitative assessment had an overall sensitivity and specificity for detecting significant stenoses of 77 % and 80 %, respectively. By adding MPRI analysis, in cases with negative qualitative assessment, the overall sensitivity increased to 83 %. The impact of MPRI differed depending on the territory; with the sensitivity for detection of left circumflex (LCx) stenosis improving the most after semi-quantification analysis, (66 % versus 83 %).
  
  
  CONCLUSIONS
  Pure qualitative assessment of 3 T MRI had acceptable performance in detecting severe CAD. There is no overall benefit of incorporating semi-quantitative data; however a higher sensitivity can be obtained by adding MPRI, especially in the detection of LCx lesions.
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, 155 Li-Nong St., Sec. 2, Taipei, 112, Taiwan.|Department of Radiology, Mackay Memorial Hospital, No. 92, Sec 2, Chungshan N. Rd, Taipei, 104, Taiwan.
authors.forename: Chun-Ho
authors.initials: CH
authors.lastname: Yun
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, 155 Li-Nong St., Sec. 2, Taipei, 112, Taiwan.|Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Jui-Peng
authors.initials: JP
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Cheng-Ting
authors.initials: CT
authors.lastname: Tsai
authors.affiliation: Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, SAR, China.
authors.forename: Greta S P
authors.initials: GS
authors.lastname: Mok
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, 155 Li-Nong St., Sec. 2, Taipei, 112, Taiwan.
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Sun
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, 155 Li-Nong St., Sec. 2, Taipei, 112, Taiwan. tung@ym.edu.tw.
authors.forename: Tung-Hsin
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Department of Radiology, Mackay Memorial Hospital, No. 92, Sec 2, Chungshan N. Rd, Taipei, 104, Taiwan. Hunag5379@gamil.com.
authors.forename: Wu-Ta
authors.initials: WT
authors.lastname: Huang
authors.affiliation: Department of Radiology, Mackay Memorial Hospital, No. 92, Sec 2, Chungshan N. Rd, Taipei, 104, Taiwan.
authors.forename: Fei-Shih
authors.initials: FS
authors.lastname: Yang
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, 155 Li-Nong St., Sec. 2, Taipei, 112, Taiwan.
authors.forename: Jason Jeun-Shenn
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Cardiovascular MRI and CT Program, Baptist Cardiac Vascular Institute, Miami, FL, USA.
authors.forename: Ricardo C
authors.initials: RC
authors.lastname: Cury
authors.affiliation: Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, USA.
authors.forename: Anas
authors.initials: A
authors.lastname: Fares
authors.affiliation: Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, USA.
authors.forename: Lemba Dina
authors.initials: LD
authors.lastname: Nshisso
authors.affiliation: Cardiovascular Department, University Hospitals Case Medical Center, Cleveland, USA.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001331:Automation; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media