High-resolution myocardial stress perfusion at 3 T in patients with suspected coronary artery disease

Abstract

To implement a high-resolution first-pass myocardial perfusion imaging protocol (HRPI) at 3 T, and to evaluate the feasibility, image quality and accuracy of this approach prospectively in patients with suspected CAD. We hypothesized that utilizing the gain in SNR at 3 T to increase spatial resolution would reduce partial volume effects and subendocardial dark rim artifacts in comparison to 1.5 T. HRPI studies were performed on 60 patients using a segmented k-space gradient echo sequence (in plane resolution 1.97 x 1.94 mm(2)). Semiquantitative assessment of dark rim artifacts was performed for the stress studies on a slice-by-slice basis. Qualitative visual analysis was compared to quantitative coronary angiography (QCA) results; hemodynamically significant CAD was defined as stenosis >or=70% at QCA. Dark rim artifacts appeared in 108 of 180 slices (average extent 1.3 +/- 1.2 mm representing 11.8 +/- 10.8% of the transmural myocardial thickness). Sensitivity, specifity, and test accuracy for the detection of significant CAD were 89%,79%, and 85%. HRPI studies at 3 T are feasible in a clinical setting, providing good image quality and high accuracy for detection of significant CAD. The presence of dark rim artifacts does not appear to represent a diagnostic problem when using a HRPI approach.

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

“…Sensitivities of 81-93% and specificities of 68-90% have been reported for stress first-pass perfusion MRI in the detection of clinically significant coronary artery disease (CAD) as defined at coronary angiography [9][10][11][12][13][14][15][16][17]. However, to the best of out knowledge, there are only three multicenter studies demonstrating the diagnostic performance of firstpass perfusion MRI for the detection of CAD [12][13][14].…”

Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography

“…These findings might mean that it is possible to estimate the homology in the severity of myocardial perfusion between SPECT and CMR via CT-MBF derived from dynamic CTP. There was no significant difference between normal and minimal ischemic segments in CMR because the dark rim artefacts might be involved with minimal myocardial ischemia [24]. Although diagnostic performance of detecting abnormal segments and severe myocardial infarction were comparable to prior studies [13][14][15][16][17][18][19], the CT-MBFs of significant myocardial ischemia and subendocardial infarction in CMR were overlapped.…”

“…4a-c and 5a-b). We independently set sub-classification of abnormal perfusion segments and severely infarcted segments in SPECT and CMR group for the study [9,22,24,25]. However, interestingly, their cut-off values of SPECT and CMR were comparable for detecting abnormal perfusion segments (1.23 mL/g/min for SPECT and 1.25 mL/g/min for CMR) and severe myocardial infarction (0.92 mL/g/min for SPECT and 0.98 mL/g/min for CMR), respectively.…”

“…All myocardial segments were classified into three groups: (i) normal, a segment presented normal perfusion in both stress and rest image, and no LGE; (ii) minimal myocardial ischemia, a segment with a PD (<25 % of the LVWT), (iii) significant myocardial ischemia, a segment with a PD (≥25 % of the LVWT) not to contaminate dark rim artefact, persisting for at least 10 frames in stress image [9,24] and no LGE; (iv) subendocardial infarction, a segment with any PD in stress image and subendocardial LGE (<50 % of the LVWT) in late image, (v) transmural infarction, a segment with any PD in stress image and transmural LGE (≥50 % of the LVWT) in late image, respectively. In this study, significant ischemia and infarction were considered abnormal perfusion segments.…”

Dobutamine stress tagging and gradient-echo imaging for detection of coronary heart disease at 3 T

“…With their increasing use in clinical routine, 3 T MR systems are also used more and more for cardiac applications [1][2][3][4][5][6]. Many theoretical advantages of high-field imaging directly translate into improved image quality for cardiac applications, e.g.…”