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

Abstract

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.

Splenic T1-mapping: a novel quantitative method for assessing adenosine stress adequacy for cardiovascular magnetic resonance

“…However, perfusion CMR has a reported false-negative rate of between 5 and 16% [2–4], which may lead to suboptimal management strategies. In the absence of poor image quality, inadequate adenosine stress response is the commonest cause of false-negative perfusion scans [4], because conventional hemodynamic markers of stress response, such as heart rate and systolic blood pressure, are unreliable predictors of myocardial vasodilatation and the achievement of maximal hyperemia [5]. …”

Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

“…Stress CMR has a reported false-negative rate of 5-16% [28][29][30]. In our study, 131 of 150 patients had normal perfusion CMR findings, but 50 of the 131 patients (38%) had inadequate stress (Table 7).…”

Are you stressed?

“…7,8 Data suggest that up to one third of these false-negative scans are related to inadequate stress either through administration errors or drug interactions. 9 This points out the importance of adequate pharmacological stress and that it is crucial to ask patients undergoing myocardial perfusion imaging to abstain from methylxanthines. Interestingly, caffeine was still present in the blood in 40% of the patients when abstaining from caffeine for 24 hours.…”