Noninvasive Detection of Myocardial Ischemia From Perfusion Reserve Based on Cardiovascular Magnetic Resonance

TLDR

Myocardial perfusion reserve can be noninvasively assessed with cardiovascular magnetic resonance. The study evaluated the diagnostic accuracy of cardiovascular MR–based myocardial perfusion reserve for detecting significant coronary artery stenosis. The authors performed first‑pass gadolinium‑DTPA perfusion imaging with dipyridamole stress in 15 patients with single‑vessel disease and 5 controls, used a linear fit of the upslope to define a perfusion reserve cutoff, and prospectively validated the method in 34 patients against coronary angiography. Myocardial perfusion reserve was significantly lower in ischemic segments (1.08 ± 0.23 vs 2.33 ± 0.41; P < 0.001), yielding a cutoff of 1.5 that achieved 90 % sensitivity, 83 % specificity, and 87 % accuracy for detecting ≥75 % coronary stenosis, with low observer variability.

Abstract

Myocardial perfusion reserve can be noninvasively assessed with cardiovascular MR. In this study, the diagnostic accuracy of this technique for the detection of significant coronary artery stenosis was evaluated.In 15 patients with single-vessel coronary artery disease and 5 patients without significant coronary artery disease, the signal intensity-time curves of the first pass of a gadolinium-DTPA bolus injected through a central vein catheter were evaluated before and after dipyridamole infusion to validate the technique. A linear fit was used to determine the upslope, and a cutoff value for the differentiation between the myocardium supplied by stenotic and nonstenotic coronary arteries was defined. The diagnostic accuracy was then examined prospectively in 34 patients with coronary artery disease and was compared with coronary angiography. A significant difference in myocardial perfusion reserve between ischemic and normal myocardial segments (1.08+/-0.23 and 2.33+/-0.41; P<0.001) was found that resulted in a cutoff value of 1.5 (mean minus 2 SD of normal segments). In the prospective analysis, sensitivity, specificity, and diagnostic accuracy for the detection of coronary artery stenosis (> or =75%) were 90%, 83%, and 87%, respectively. Interobserver and intraobserver variabilities for the linear fit were low (r=0.96 and 0.99).MR first-pass perfusion measurements yielded a high diagnostic accuracy for the detection of coronary artery disease. Myocardial perfusion reserve can be easily and reproducibly determined by a linear fit of the upslope of the signal intensity-time curves.