Diagnostic Performance of Noninvasive Myocardial Perfusion Imaging Using Single-Photon Emission Computed Tomography, Cardiac Magnetic Resonance, and Positron Emission Tomography Imaging for the Detection of Obstructive Coronary Artery Disease

Jaarsma, Caroline; Leiner, Tim; Bekkers, Sebastiaan C.A.M.; Crijns, Harry J.G.M.; Wildberger, Joachim E.; Nagel, Eike; Nelemans, Patricia J.; Schalla, Simon

doi:10.1016/j.jacc.2011.12.040

Cited by 401 publications

(239 citation statements)

References 37 publications

(31 reference statements)

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“…Despite challenges, false‐negative MR perfusion studies are uncommon. A recent meta‐analysis of perfusion MR revealed false‐negative rates of 0–16% from the 34 vasodilator stress studies analyzed, comparable to our incidence of 5% of all CE‐MARC patients 6. The largest study in the meta‐analysis (21 false‐negative patients) was prone to verification bias, as it was neither randomized nor prospective 17.…”

Section: Discussionsupporting

confidence: 76%

“…While having a significant univariate relationship to a false‐negative finding, this was not the case when adjusting for other variables. In the meta‐analysis described above,6 there was no significant chronological change in false‐negative rates, suggesting that improvements in imaging technique, while striving to improve diagnostic accuracy, may have a limited role in reducing the frequency of false‐negative results. Consistent with this notion, we found that most false‐negative results were associated with factors outside of the imaging acquisition.…”

Section: Discussionmentioning

confidence: 95%

“…False‐negative perfusion MR studies are an important limitation of the method, reported to occur in ∼16% of cases and potentially denying patients appropriate revascularization treatment 6. Reasons for false‐negative perfusion MR studies include suboptimal image quality, technical failure, and the inconsistent relationship between angiographic stenosis severity and myocardial ischemia in studies using angiographic endpoints 7.…”

mentioning

confidence: 99%

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Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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PurposeTo examine factors associated with false‐negative cardiovascular magnetic resonance (MR) perfusion studies within the large prospective Clinical Evaluation of MR imaging in Coronary artery disease (CE‐MARC) study population. Myocardial perfusion MR has excellent diagnostic accuracy to detect coronary heart disease (CHD). However, causes of false‐negative MR perfusion studies are not well understood.Materials and MethodsCE‐MARC prospectively recruited patients with suspected CHD and mandated MR, myocardial perfusion scintigraphy, and invasive angiography. This subanalysis identified all patients with significant coronary stenosis by quantitative coronary angiography (QCA) and MR perfusion (1.5T, T 1‐weighted gradient echo), using the original blinded image read. We explored patient and imaging characteristics related to false‐negative or true‐positive MR perfusion results, with reference to QCA. Multivariate regression analysis assessed the likelihood of false‐negative MR perfusion according to four characteristics: poor image quality, triple‐vessel disease, inadequate hemodynamic response to adenosine, and Duke jeopardy score (angiographic myocardium‐at‐risk score).ResultsIn all, 265 (39%) patients had significant angiographic disease (mean age 62, 79% male). Thirty‐five (5%) had false‐negative and 230 (34%) true‐positive MR perfusion. Poor MR perfusion image quality, triple‐vessel disease, and inadequate hemodynamic response were similar between false‐negative and true‐positive groups (odds ratio, OR [95% confidence interval, CI]: 4.1 (0.82–21.0), P = 0.09; 1.2 (0.20–7.1), P = 0.85, and 1.6 (0.65–3.8), P = 0.31, respectively). Mean Duke jeopardy score was significantly lower in the false‐negative group (2.6 ± 1.7 vs. 5.4 ± 3.0, OR 0.34 (0.21–0.53), P < 0.0001).ConclusionFalse‐negative cardiovascular MR perfusion studies are uncommon, and more common in patients with lower angiographic myocardium‐at‐risk. In CE‐MARC, poor image quality, triple‐vessel disease, and inadequate hemodynamic response were not significantly associated with false‐negative MR perfusion. J. MAGN. RESON. IMAGING 2016;43:566–573.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Kidambi

Sourbron

Maredia

et al. 2015

Magnetic Resonance Imaging

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“…82 Rb MPS has been validated for the diagnosis of obstructive CAD and is as sensitive but more specific than SPECT MPS. 13,14 Accordingly, 82 Rb offers the only current realistic choice of tracer if widespread adoption of PET MPS was to be recommended.…”

Section: Which Pet Tracer Is a Realistic Choice For Widespread Use Inmentioning

confidence: 99%

PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD

Stirrup

Underwood

2017

Journal of Nuclear Cardiology

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“…[16][17][18][19]30,31 Adenosine stress perfusion CMR is highly sensitive, specific, and reproducible for identification of obstructive CAD and has been reported to be superior to other stress imaging methods for this purpose. [32][33][34][35][36][37][38] In the setting of stable, nonobstructive CAD, patients with proven microvascular disease based on invasive coronary reactivity testing had lower MPRI as compared with healthy controls. 39 In our study, when stress perfusion was abnormal in patients with LGE or T2+, abnormal perfusion was typically identified in the affected myocardial segments.…”

Section: Cmr Evidence Of Infarction (Lge)mentioning

confidence: 99%

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Mauricio

Srichai

Axel

et al. 2016

Clinical Cardiology

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BackgroundIn a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine‐stress CMR (sCMR).HypothesisAbnormal perfusion may co‐localize with ischemic late gadolinium enhancement (LGE) and T2‐weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI.MethodsQualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84.ResultsAbnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption.ConclusionsAbnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co‐localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.

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Diagnostic Performance of Noninvasive Myocardial Perfusion Imaging Using Single-Photon Emission Computed Tomography, Cardiac Magnetic Resonance, and Positron Emission Tomography Imaging for the Detection of Obstructive Coronary Artery Disease

Cited by 401 publications

References 37 publications

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

Factors associated with false‐negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE‐MARC) substudy

PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

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