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Jahnke, C; Gebker, R; Manka, R; Schnackenburg, B; Fleck, E; Paetsch, I (2010). Navigator-gated 3D blood oxygen level-dependent CMR at 3.0-T for detection of stress-induced myocardial ischemic reactions. JACC. Cardiovascular imaging, 3(4):375-84.

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Objectives: This study determined the value of navigator-gated 3-dimensional blood oxygen level–dependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions.

Background: Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies.

Methods: Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction ≥50%). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [{Delta}SI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]).

Results: The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90% and 84% of the patients, respectively. The {Delta}SI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p < 0.001). The receiver-operator characteristic analysis identified a cutoff value of {Delta}SI = 2.7% for the detection of coronary stenosis, resulting in a sensitivity and specificity of 85.0% and 80.5%, respectively. An MPRI cutoff value of 1.35 yielded a sensitivity and specificity of 89.5% and 85.8%, respectively. The {Delta}SI significantly correlated with the degree of coronary stenosis (r = –0.65, p < 0.001). Additionally, {Delta}SI and MPRI showed substantial agreement (kappa value 0.66).

Conclusions: Navigator-gated 3-dimensional BOLD imaging at 3.0-T reliably detected stress-induced myocardial ischemic reactions and may be considered a valid alternative to first-pass exogenous contrast-enhancement studies.


25 citations in Web of Science®
29 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
04 Faculty of Medicine > Institute of Biomedical Engineering
Dewey Decimal Classification:170 Ethics
610 Medicine & health
Date:1 April 2010
Deposited On:05 Jan 2011 07:51
Last Modified:05 Apr 2016 14:32
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:10.1016/j.jcmg.2009.12.008
PubMed ID:20394899

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