Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease

Cury, Ricardo C.; C, Cattani; Gabure, Luiz Augusto Gadia; Racy, Douglas Jorge; Gois, Jose M. de; Siebert, Uwe; Lima, Swiany Silveira; Brady, Thomas J.

doi:10.1148/radiol.2401051161

Cited by 96 publications

(52 citation statements)

References 22 publications

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“…As a matter of fact, a recent populationbased study in Sweden showed that 19.8% of randomly selected 70-year-old subjects had subclinical myocardial infarct reflected as focal area of LGE [27]. Several studies have demonstrated that combining LGE MRI with stress-rest perfusion MRI can improve the sensitivity of MRI for obstructive CAD without deteriorating the specificity when only obvious myocardial infarction (i.e., LGE consistent with a coronary distribution) were considered [28,29]. However, correlating the presence of LGE with flow-limiting obstructive CAD can be inappropriate since microinfarcts may occur without coronary artery narrowing as a result of plaque rupture/ ulceration and subsequent washout of the lipid pool with or without additional thrombus formation into the microcirculation [30,31].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of stress myocardial perfusion MRI and late gadolinium-enhanced MRI for detecting flow-limiting coronary artery disease: a multicenter study

et al. 2008

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The aim of this study was to determine the diagnostic performance of stress and rest perfusion magnetic resonance imaging (MRI) and late gadolinium-enhanced (LGE) MRI for identifying patients with obstructive coronary artery disease (CAD). A total of 50 patients with suspected CAD underwent stress-rest perfusion MRI, followed by LGE MRI with a 1.5-T system. Stress-rest perfusion MRI resulted in an area under the receiveroperating characteristic curve (AUC) of 0.92 for observer 1 and 0.84 for observer 2 with sensitivity and specificity of 89% (32/36) and 79% (11/14) by observer 1, 83% (30/36) and 71% (10/14) by observer 2, respectively, showing a moderate interobserver agreement (Cohen's κ= 0.49). While combination of stressrest perfusion and LGE MRI did not result in improved accuracy for the prediction of flow-limiting obstructive CAD (AUC 0.81 for observer 1 and 0.80 for observer 2), the sensitivity was increased to 92% in both observers with a substantial interobserver agreement (κ=0.70). Stress-rest myocardial perfusion MRI is an accurate diagnostic test for identifying patients with obstructive CAD.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of stress myocardial perfusion MRI and late gadolinium-enhanced MRI for detecting flow-limiting coronary artery disease: a multicenter study

et al. 2008

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“…50%) or in patients with a lower likelihood of disease or risk factors. Single-center (32,35,37,41) and multicenter (42) studies have shown FIGURE 3. MBF can increase 3-to 4-fold during submaximal increase in cardiac workload to match increased myocardial oxygen demand.…”

Section: Mbf Measurement: Recent Advances Cmrmentioning

confidence: 99%

The Clinical Value of Myocardial Blood Flow Measurement

2009

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PET provides robust and reproducible measurements of regional myocardial blood flow in milliliters per minute per gram of tissue, providing unique pathophysiologic and diagnostic information on the function of the coronary macro-and microcirculation. There is compelling evidence to suggest that in many instances abnormalities of global myocardial perfusion are demonstrated in individuals with either coronary risk factors for coronary artery disease or different myocardial diseases in the absence of angiographically demonstrable stenosis of the epicardial coronary arteries. In this context, measurement of myocardial blood flow gives unique diagnostic information regarding the function of the coronary microcirculation and provides a quantitative surrogate endpoint against which the efficacy of treatments can be established.

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“…But there is also a dilemma for cardiologists and their patients with known CAD, after multiple coronary interventions and finally coronary bypass grafting, who after a symptom-free period of three years develop angina again. Neither established diagnostic methods such as 12-lead ECG, [15][16][17][18][19][20]. Transient myocardial ischaemia, however, causes well-recognizable changes in a variety of MCG parameters, first described by Cohen and Kaufman in 1975 [21].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Special article Magnetocardiography in clinical cardiology. Status quo and future applications

Leithäuser¹,

Jung²,

Park³

2011

pwki

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215Magnetocardiography in clinical cardiology. Status quo and future applications Magnetokardiografia w kardiologii klinicznej. Stan obecny i przyszłe zastosowania B Bo or ri is s L Le ei it th hä äu us se er r 1 1 , , F Fr ri ie ed dr ri ic ch h J Ju un ng g 2 2 , , J Ja ai i--W Wu un n P Pa ar rk k Special article/Artykuł specjalny A b s t r a c tMagnetocardiography (MCG) is a non-contact, non-invasive technique for the assessment of electromagnetic activity of the human heart. Theoretical considerations and comparative studies indicate different information content between MCG and electrocardiography (ECG). Although many questions about cardiac pathophysiology and electrophysiology can be answered by MCG studies, measurement of biomagnetism is still only marginally recognized as a valuable tool. Although MCG instrumentation (SQUIDs, MSR) and operation (liquid helium) are expensive and not available at the bedside, the gain of information drawn from the cardiac magnetic field is worth the effort. The MCG has superior sensitivity for ischaemic myocardium both at rest and under stress. Therefore, it may change one's ideas of decision making about invasive procedures. Compared to scintigraphy, which is a cumbersome method with the need of radioactivity exposure to the patient, MCG is as easy as bicycle ergometry but with higher sensitivity. In terms of risk stratification for sudden cardiac death, it seems to be possible that MCG in the future will provide additional information as to which patient will not benefit from prophylactic defibrillator implantation. However, appropriate clinical studies are lacking. Most interestingly, MCG appears to be practical and informative in the diagnosis of cardiac arrhythmias, and has sufficient spatial accuracy necessary for clinical purposes. It seems realistic that MCG-based localization of arrhythmogenic spots may guide the operator's ablation catheter, e.g. in patients with relapsing AF after a first successful ablation procedure. There is enough room for fantasy which question in clinical cardiology remains to be answered by MCG. K Ke ey y w wo or rd ds s: : magnetocardiography, coronary heart disease, ischaemia, risk stratification, arrhythmia, atrial fibrillation S t r e s z c z e n i e Magnetokardiografia (ang. magnetocardiography, MCG) jest bezkontaktową, nieinwazyjną metodą pomiaru pola magnetycznego ludzkiego serca. Założenia teoretyczne oraz badania porównawcze wskazują, że MCG i EKG dostarczają odmiennych informacji. Pomiar pola magnetycznego jest nadal w niewielkim stopniu uważany za wartościowe narzędzie, pomimo że badania MCG mogą udzielić odpowiedzi na wiele pytań dotyczących patofizjologii serca i elektrofizjologii. Chociaż oprzyrządowanie konieczne do MCG (SQUIDs, MSR) i jego obsłu-ga (ciekły hel) są drogie i nie są dostępne jako badania przyłóżkowe, to informacja uzyskiwana z badań pola magnetycznego serca jest warta tych wysiłków. Magnetokardiografia charakteryzuje się większą czułością w wykrywaniu niedokrwienia miokardium zarówno w warunkach spoczynkow...

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Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease

Abstract: Stress first-pass perfusion MR imaging followed by delayed-enhancement imaging is an accurate method to depict significant coronary stenosis in patients suspected of having or known to have CAD.

Cited by 96 publications

References 22 publications

Diagnostic accuracy of stress myocardial perfusion MRI and late gadolinium-enhanced MRI for detecting flow-limiting coronary artery disease: a multicenter study

Diagnostic accuracy of stress myocardial perfusion MRI and late gadolinium-enhanced MRI for detecting flow-limiting coronary artery disease: a multicenter study

The Clinical Value of Myocardial Blood Flow Measurement

Special article Magnetocardiography in clinical cardiology. Status quo and future applications

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