Adenosine Stress Cardiovascular Magnetic Resonance With Variable-Density Spiral Pulse Sequences Accurately Detects Coronary Artery Disease

Abstract

Background Adenosine stress CMR perfusion imaging can be limited by motion-induced dark-rim artifacts (DRA), which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral (VDS) pulse sequence with a novel density compensation strategy has been shown to reduce DRA in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress CMR using this new perfusion sequence to detect obstructive coronary artery disease (CAD). Methods and Results CMR perfusion imaging was performed during adenosine stress (140μg/kg-min) and at rest on a Siemens 1.5T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography (CA). Perfusion images were acquired during injection of 0.1mmol/kg Gd-DTPA at 3 short-axis locations using a saturation recovery (SR) interleaved VDS pulse sequence. Significant stenosis was defined as >50% by quantitative CA (QCA). Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5 point scale (1 – poor to 5- excellent). The prevalence of obstructive CAD by QCA was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88% respectively with a positive predictive value and negative predictive value of 93% and 79% respectively. The average image quality score was 4.4±0.7 with only one study with more than mild DRA. There was good inter-reader reliability with a kappa statistic of 0.67. Conclusions Spiral adenosine stress CMR results in high diagnostic accuracy for the detection of obstructive CAD with excellent image quality and minimal DRA.

Recent Advances in Cardiovascular Magnetic Resonance

“…15 Spiral perfusion CMR is effective in reducing DRA, 17,18 enabling visualization of subendocardial perfusion defects (Figure 3B) with good clinical performance in a single-center study. 19 Recent spiral approaches using compressed sensing have enabled wholeheart data acquisition. 6 …”

“…Variable density spiral sampling with apodization can detect subendocardial defects without dark-rim artifacts. Reprinted from Salerno et al 19 with permission of the publisher. Copyright ©2014, Wolters Kluwer Health, Inc. C , High-resolution (1.4 mm) non-Cartesian perfusion CMR performed using non-ECG-gated continuous acquisition radial sampling enables systolic imaging of all slices at 3T at stress ( top ) and rest ( bottom ) in a patient with a history of CAD and prior revascularization.…”

First-pass myocardial perfusion MRI with reduced subendocardial dark-rim artifact using optimized Cartesian sampling

“…Apodized image reconstruction, which is equivalent to a “data weighting” scheme in k ‐space, has been applied to non‐Cartesian trajectories such as radial and spiral to suppress Gibbs ringing artifacts. In this work, a Gaussian kernel is used as the apodization function: where the predefined apodization parameters Ω x and Ω y determine the “degree” of apodization along k x and k y dimensions, respectively.…”

“…More recently, non‐Cartesian trajectories, specifically spiral and radial sampling, have also been applied to reduce DRA . However, these trajectories are not available on most clinical scanners, especially when parallel imaging reconstruction is needed.…”

“…More recently, non-Cartesian trajectories, specifically spiral and radial sampling, have also been applied to reduce DRA. [14][15][16] However, these trajectories are not available on most clinical scanners, especially when parallel imaging reconstruction is needed. Despite their promise, lack of integrated/online instantaneous image reconstruction and lack of robustness at 3T (challenge of maintaining k-space trajectory fidelity) have arguably limited the availability of non-Cartesian FPP techniques in routine clinical protocols.…”