Roles of myocardial blood volume and flow in coronary artery disease: an experimental MRI study at rest and during hyperemia

McCommis, Kyle S.; Goldstein, Thomas; Abendschein, Dana R.; Misselwitz, Bernd; Pilgram, Thomas K.; Gropler, Robert J.; Zheng, Jie

doi:10.1007/s00330-010-1740-8

Cited by 26 publications

(34 citation statements)

References 29 publications

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“…For the quantitative analysis, the segmentation mask created to extract quantitative data from each ROI had the same resolution as the DWI images. Third, an average myocardial blood volume of 5–15% has been reported in dogs. Therefore, blood pseudo diffusion might interfere with the quantitation of true diffusion .…”

Section: Discussionmentioning

confidence: 98%

In vivo diffusion tensor MRI of the human heart: Reproducibility of breath‐hold and navigator‐based approaches

Nielles‐Vallespin

Mekkaoui

Gatehouse

et al. 2012

Magnetic Resonance in Med

152

235

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The aim of this study was to implement a quantitative in vivo cardiac diffusion tensor imaging (DTI) technique that was robust, reproducible, and feasible to perform in patients with cardiovascular disease. A stimulated-echo single-shot echo-planar imaging (EPI) sequence with zonal excitation and parallel imaging was implemented, together with a novel modification of the prospective navigator (NAV) technique combined with a biofeedback mechanism. Ten volunteers were scanned on two different days, each time with both multiple breath-hold (MBH) and NAV multislice protocols. Fractional anisotropy (FA), mean diffusivity (MD), and helix angle (HA) fiber maps were created. Comparison of initial and repeat scans showed good reproducibility for both MBH and NAV techniques for FA (P > 0.22), MD (P > 0.15), and HA (P > 0.28). Comparison of MBH and NAV FA (FAMBHday1 = 0.60 ± 0.04, FANAVday1 = 0.60 ± 0.03, P = 0.57) and MD (MDMBHday1 = 0.8 ± 0.2 × 1023 mm2/s, MDNAVday1 = 0.9 ± 0.2 × 10−3 mm2/s, P = 0.07) values showed no significant differences, while HA values (HAMBHday1Endo = 22 ± 10°, HAMBHday1Mid-Endo = 20 ± 6°, HAMBHday1Mid-Epi = −1 ± 6°, HAMBHday1Epi = 17 ± 6°, HANAVday1Endo = 7 ± 7°, HAMBHday1Mid-Endo = 13 ± 8°, HAMBHday1Epi = −2 ± 7°, HAMBHday1Epi −14 ± 6°,) were significantly different. The scan duration was 20% longer with the NAV approach. Currently, the MBH approach is the more robust in normal volunteers. While the NAV technique still requires resolution of some bulk motion sensitivity issues, these preliminary experiments show its potential for in vivo clinical cardiac diffusion tensor imaging and for delivering high-resolution in vivo 3D DTI tractography of the heart.

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Section: Discussionmentioning

confidence: 98%

In vivo diffusion tensor MRI of the human heart: Reproducibility of breath‐hold and navigator‐based approaches

Nielles‐Vallespin

Mekkaoui

Gatehouse

et al. 2012

Magnetic Resonance in Med

152

235

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“…Measured fMBV values in the volunteers, even after correction for partial binding of contrast agent to albumin, over-estimate published values for myocardial blood volume in animal and human subjects [2,3,42,48]. The true vascular fraction obtained after accounting for leakage and two-compartment water exchange approaches the value of ECV in healthy volunteers (23–25%) [49], which suggests that the intravascular assumption may not be appropriate for gadofosveset.…”

Section: Discussionmentioning

confidence: 83%

Leakage and water exchange characterization of gadofosveset in the myocardium

Bane

Lee

Benefield

et al. 2014

Magnetic Resonance Imaging

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Purpose To determine the compartmentalization of the blood pool agent gadofosveset and the effect of its transient binding to albumin on the quantification of steady-state fractional myocardial blood volume (fMBV). Methods Myocardial vascular fraction measurements were simulated assuming the limiting cases (slow or fast) of two-compartment water exchange for different contrast agent injection concentrations, binding fractions, bound and free relaxivities, and true cardiac vascular fractions. fMBV was measured in five healthy volunteers (4 males, 1 female, average age 33) at 1.5 T after administration of five injections of gadofosveset. The measurements in the volunteers were retrospectively compared to measurements of fMBV after three serial injections of the ultra-small, paramagnetic iron oxide (USPIO) blood pool agent ferumoxytol in an experimental animal. The true fMBV and exchange rate of water protons in both human and animal data sets was determined by chi square minimization. Results Simulations showed an error in the measurement of fMBV due to partial binding of gadofosveset of less than 30%. Measured fMBV values over-estimate simulation predictions, and approach cardiac extracellular volume (22%), which suggests that the intravascular assumption may not be appropriate for the myocardium, although it may apply to more distal perfusion beds. In comparison, fMBV measured with ferumoxytol (5%, with slow water proton exchange across vascular wall) agree with published values of myocardial vascular fraction. Further comparison between myocardium relaxation rates induced by gadofosveset and by other extracellular and intravascular contrast agents showed that gadofosveset behaves like an extracellular contrast agent. Conclusions The distribution of the volunteer data indicates that a three-compartment model, with slow water exchange of gadofosveset and water protons between the vascular and interstitial compartments, and fast water exchange between the interstitium and the myocytes, is appropriate. The ferumoxytol measurements indicate that this USPIO is an intravascular contrast agent that can be used to quantify myocardial blood volume, with the appropriate correction for water exchange using a two-compartment water exchange model.

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“…dobutamine) are preferred to induce regional wall motion abnormalities [4,12]. However, dobutamine has been shown to increase coronary flow to a degree comparable to that achieved with vasodilator stress [13]. Administration of dobutamine thus can cause perfusion deficits owing to a diminished flow reserve, which may already be seen with stenoses that exceed 50%.…”

Section: Discussionmentioning

confidence: 98%

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

Gebker

Frick

Jahnke

et al. 2010

Int J Cardiovasc Imaging

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This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50-70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a ≥ 50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P < 0.001) with a non-significant reduction in specificity (85 vs. 90%, P = 0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P = 0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P = 0.03), but not in patients with severe (≥70%) stenosis (93 vs. 84%, P = 0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P = 0.001) resulting in a lower overall accuracy (71 vs 74%, P = 0.03). Using a cutoff of ≥50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P = 0.03) and multi vessel disease (93 vs. 79%, P = 0.03), whereas no significant differences were found using a cutoff of ≥70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ≥50% stenosis. In patients with ≥70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.

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Roles of myocardial blood volume and flow in coronary artery disease: an experimental MRI study at rest and during hyperemia

Cited by 26 publications

References 29 publications

In vivo diffusion tensor MRI of the human heart: Reproducibility of breath‐hold and navigator‐based approaches

In vivo diffusion tensor MRI of the human heart: Reproducibility of breath‐hold and navigator‐based approaches

Leakage and water exchange characterization of gadofosveset in the myocardium

Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

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