Contrast-enhanced cardiac MR imaging in the detection of reduced coronary flow velocity reserve.

TY - JOUR

T1 - Contrast-enhanced cardiac MR imaging in the detection of reduced coronary flow velocity reserve.

AU - Barmeyer, Achim

AU - Stork, Alexander

AU - Müllerleile, Kai

AU - Tiburtius, Claudia

AU - Schofer, Anne K

AU - Heitzer, Thomas

AU - Hofmann, Thomas

AU - Adam, Gerhard

AU - Meinertz, Thomas

AU - Lund, Gunnar

PY - 2007

Y1 - 2007

N2 - PURPOSE: To prospectively evaluate the accuracy of contrast material-enhanced cardiac magnetic resonance (MR) imaging for determining impaired coronary flow velocity reserve (CFR) by using Doppler flow measurement as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional ethics committee, and all patients gave written informed consent. Eligible patients underwent contrast-enhanced cardiac MR imaging and invasive measurement of CFR. For contrast-enhanced MR imaging, a three-section single-shot saturation recovery gradient-recalled echo sequence with steady-state free precession was used. Sections were divided into six segments. For each segment, a transmural and subendocardial myocardial perfusion reserve index (MPRI) was calculated by using the upslope of the signal intensity-time curve during the first pass of contrast material at rest and during adenosine infusion (140 microg per kilogram body weight per minute). MPRIs of vascular regions were compared with the corresponding CFR. Receiver operating characteristic (ROC) analysis was performed to find the number of segments needed for best diagnostic accuracy of MPRI and to find a cutoff value for MPRI in the detection of a reduced CFR. RESULTS: Thirty-five patients were evaluated (male-to-female ratio, 27:8; mean age +/- standard deviation, 63.5 years +/- 8.2; mean body mass index, 28.8 kg/m(2) +/- 3.8), and 43 vascular regions were analyzed. A linear correlation was found between the MPRI and CFR (r = 0.44, P <.05). The MPRI was significantly lower in vascular regions with a CFR of less than 2.00 than in regions with a CFR of 2.00 or greater (P <.05). Detection of a CFR of less than 2.00 was more accurate with subendocardial MPRI measurements than with transmural measurements. The mean subendocardial MPRI of the segments with the three lowest MPRIs of a vascular region showed the best diagnostic performance in the detection of a CFR of less than 2.00 (area under the ROC curve, 0.85; sensitivity, 84%; specificity, 75%) by using a cutoff value of 1.21. CONCLUSION: The diagnostic accuracy of subendocardial perfusion analysis in contrast-enhanced cardiac MR imaging is higher than that of transmural analysis.

AB - PURPOSE: To prospectively evaluate the accuracy of contrast material-enhanced cardiac magnetic resonance (MR) imaging for determining impaired coronary flow velocity reserve (CFR) by using Doppler flow measurement as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional ethics committee, and all patients gave written informed consent. Eligible patients underwent contrast-enhanced cardiac MR imaging and invasive measurement of CFR. For contrast-enhanced MR imaging, a three-section single-shot saturation recovery gradient-recalled echo sequence with steady-state free precession was used. Sections were divided into six segments. For each segment, a transmural and subendocardial myocardial perfusion reserve index (MPRI) was calculated by using the upslope of the signal intensity-time curve during the first pass of contrast material at rest and during adenosine infusion (140 microg per kilogram body weight per minute). MPRIs of vascular regions were compared with the corresponding CFR. Receiver operating characteristic (ROC) analysis was performed to find the number of segments needed for best diagnostic accuracy of MPRI and to find a cutoff value for MPRI in the detection of a reduced CFR. RESULTS: Thirty-five patients were evaluated (male-to-female ratio, 27:8; mean age +/- standard deviation, 63.5 years +/- 8.2; mean body mass index, 28.8 kg/m(2) +/- 3.8), and 43 vascular regions were analyzed. A linear correlation was found between the MPRI and CFR (r = 0.44, P <.05). The MPRI was significantly lower in vascular regions with a CFR of less than 2.00 than in regions with a CFR of 2.00 or greater (P <.05). Detection of a CFR of less than 2.00 was more accurate with subendocardial MPRI measurements than with transmural measurements. The mean subendocardial MPRI of the segments with the three lowest MPRIs of a vascular region showed the best diagnostic performance in the detection of a CFR of less than 2.00 (area under the ROC curve, 0.85; sensitivity, 84%; specificity, 75%) by using a cutoff value of 1.21. CONCLUSION: The diagnostic accuracy of subendocardial perfusion analysis in contrast-enhanced cardiac MR imaging is higher than that of transmural analysis.

M3 - SCORING: Zeitschriftenaufsatz

VL - 243

SP - 377

EP - 385

JO - RADIOLOGY

JF - RADIOLOGY

SN - 0033-8419

IS - 2

M1 - 2

ER -