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Dynamic 3-dimensional stress cardiac magnetic resonance perfusion imaging: detection of coronary artery disease and volumetry of myocardial hypoenhancement before and after coronary stenting


Manka, R; Jahnke, C; Kozerke, S; Vitanis, V; Crelier, G; Gebker, R; Schnackenburg, B; Boesiger, P; Fleck, E; Paetsch, I (2011). Dynamic 3-dimensional stress cardiac magnetic resonance perfusion imaging: detection of coronary artery disease and volumetry of myocardial hypoenhancement before and after coronary stenting. Journal of the American College of Cardiology, 57(4):437-444.

Abstract

OBJECTIVES:

The aim of this study was to establish a new, dynamic 3-dimensional cardiac magnetic resonance (3D-CMR) perfusion scan technique exploiting data correlation in k-space and time with sensitivity-encoding and to determine its value for the detection of coronary artery disease (CAD) and volumetry of myocardial hypoenhancement (VOLUME(hypo)) before and after percutaneous coronary stenting.
BACKGROUND:

Dynamic 3D-CMR perfusion imaging might improve detection of myocardial perfusion deficits and could facilitate direct volumetry of myocardial hypoenhancement.
METHODS:

In 146 patients with known or suspected CAD, a 3.0-T CMR examination was performed including cine imaging, 3D-CMR perfusion under adenosine stress and at rest followed by delayed enhancement imaging. Quantitative invasive coronary angiography defined significant CAD (≥ 50% luminal narrowing). Forty-eight patients underwent an identical repeat CMR examination after percutaneous stenting of at least 1 coronary lesion. The 3D-CMR perfusion scans were visually classified as pathologic if ≥ 1 segment showed an inducible perfusion deficit in the absence of delayed enhancement. The VOLUME(hypo) was measured by segmentation of the area of inducible hypoenhancement and normalized to left-ventricular myocardial volume (%VOLUME(hypo)).
RESULTS:

The 3D-CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 91.7%, 74.3%, and 82.9%, respectively. Before and after coronary stenting, %VOLUME(hypo) averaged to 14.2 ± 9.5% and 3.2 ± 5.2%, respectively, with a relative VOLUME(hypo) reduction of 79.4 ± 25.4%. Intrareader and inter-reader reproducibility of VOLUME(hypo) measurements was high (Lin's concordance correlation coefficient, 0.96 and 0.96, respectively).
CONCLUSIONS:

The 3D-CMR stress perfusion provided high image quality and high diagnostic accuracy for the detection of significant CAD. The VOLUME(hypo) measurements were highly reproducible and allowed for the assessment of the treatment effect achievable by percutaneous coronary stenting.

Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

OBJECTIVES:

The aim of this study was to establish a new, dynamic 3-dimensional cardiac magnetic resonance (3D-CMR) perfusion scan technique exploiting data correlation in k-space and time with sensitivity-encoding and to determine its value for the detection of coronary artery disease (CAD) and volumetry of myocardial hypoenhancement (VOLUME(hypo)) before and after percutaneous coronary stenting.
BACKGROUND:

Dynamic 3D-CMR perfusion imaging might improve detection of myocardial perfusion deficits and could facilitate direct volumetry of myocardial hypoenhancement.
METHODS:

In 146 patients with known or suspected CAD, a 3.0-T CMR examination was performed including cine imaging, 3D-CMR perfusion under adenosine stress and at rest followed by delayed enhancement imaging. Quantitative invasive coronary angiography defined significant CAD (≥ 50% luminal narrowing). Forty-eight patients underwent an identical repeat CMR examination after percutaneous stenting of at least 1 coronary lesion. The 3D-CMR perfusion scans were visually classified as pathologic if ≥ 1 segment showed an inducible perfusion deficit in the absence of delayed enhancement. The VOLUME(hypo) was measured by segmentation of the area of inducible hypoenhancement and normalized to left-ventricular myocardial volume (%VOLUME(hypo)).
RESULTS:

The 3D-CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 91.7%, 74.3%, and 82.9%, respectively. Before and after coronary stenting, %VOLUME(hypo) averaged to 14.2 ± 9.5% and 3.2 ± 5.2%, respectively, with a relative VOLUME(hypo) reduction of 79.4 ± 25.4%. Intrareader and inter-reader reproducibility of VOLUME(hypo) measurements was high (Lin's concordance correlation coefficient, 0.96 and 0.96, respectively).
CONCLUSIONS:

The 3D-CMR stress perfusion provided high image quality and high diagnostic accuracy for the detection of significant CAD. The VOLUME(hypo) measurements were highly reproducible and allowed for the assessment of the treatment effect achievable by percutaneous coronary stenting.

Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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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
Language:English
Date:2011
Deposited On:21 Jan 2012 15:58
Last Modified:05 Apr 2016 15:27
Publisher:Elsevier
ISSN:0735-1097
Publisher DOI:10.1016/j.jacc.2010.05.067
PubMed ID:21251584
Permanent URL: http://doi.org/10.5167/uzh-56442

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