Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial)

Schwitter, Juerg; Wacker, Christian; Wilke, Norbert; Al-Saadi, Nidal; Sauer, E.; Huettle, Kalman; Schönberg, Stefan O.; Debl, Kurt; Strohm, Oliver; Åhlström, Håkan; Dill, Thorsten; Hoebel, Nadja; Símor, Tamás

doi:10.1186/1532-429x-14-61

Cited by 131 publications

(75 citation statements)

References 29 publications

(43 reference statements)

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“…The high spatial resolution of MR-MPI enables the delineation of subendocardial ischemia and myocardial infarction in patients with CAD [18]. Therefore, a comprehensive cardiac protocol involving the use of stress MR-MPI is helpful for diagnosing and managing CAD, even in patients with multivessel disease [19]. Stress MPI is essential for assessing the MAAR; therefore, many researchers have investigated stress-induced myocardial perfusion abnormalities using SPECT, MR, and CT [20] [21] [22].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Fukuyama¹,

Kurata²,

Tanabe³

et al. 2017

OJRad

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Purpose: To assess the clinical feasibility of automated segmentation of the myocardial area at risk (MAAR) using coronary computed tomography angiography (CT-MAAR), as compared to stress magnetic resonance myocardial perfusion imaging (MR-MPI). Materials and Methods: Thirty patients who underwent coronary computed tomography angiography (CTA) and stress MR-MPI were retrospectively evaluated. The myocardial territory of the left ventricle (LV) distal to coronary artery stenosis (≥50% or ≥70% stenosis on coronary CTA) was three-dimensionally quantified using a Voronoi diagram. The ratio of all stenosis-related territories to the LV volume was defined as CT-MAAR (%-LV volume). The proportion of segments with perfusion defects in stress MR-MPI to the total of 16 segments (range: 0% -100%; with a 6.3%-interval scale) was defined as the reference. Correlation was assessed using Spearman's test. The capability of CT-MAAR to predict the ischemic burden was assessed. Results: Stress MR-MPI depicted a median ischemic burden of 25.2% (range: 18.9% -44.1%) in 30 patients without myocardial infarction. When CTA stenosis criteria of ≥50% (n = 30) and ≥70% (n = 27) were applied to estimate CT-MAAR, the median CT-MAAR values were 48.2% (31.6% -64.3%) and 32.5% (23.7% -51.9%), respectively. The correlations between the CT-MAAR values and the MR-based ischemic burden were significant (0.73 and 0.97 for ≥50% and ≥70% stenosis, respectively). CT-MAAR predicted the MR-based ischemic burden within ±1 segment of %-LV (6.3%) in 40% (12/30) of patients with ≥50% stenosis, and in 81.5% (22/27) of How to cite this paper: Fukuyama, N., Kido, T., Kurata, A., Tanabe, Y., Kido, T., Yokoi, T., Ogawa, R., Nishiyama, H., Uetani, T. and Mochizuki, T. 10patients with ≥70% stenosis. Conclusions: Comprehensive assessment of resting coronary CTA combined with Voronoi diagram-based myocardial segmentation may help predict the myocardial ischemic burden in patients with severe coronary CTA stenosis.

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Section: Discussionmentioning

confidence: 99%

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Fukuyama¹,

Kurata²,

Tanabe³

et al. 2017

OJRad

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“…The disadvantage has been partial coverage of the heart. Still, previous studies comparing the diagnostic value of MPS and CMR [56,57] have shown CMR to perform well. CMR may display perfusion, wall motion and LGE in one appointment [54].…”

Section: Image Qualitymentioning

confidence: 90%

“…Areas with high perfusion display contrast enhancement and have a high signal, while areas with delayed or low perfusion have a low signal and appear dark [56,57]. Sensitivity and specificity has been shown to be in the range 91-94%/ 81-88% [28].…”

Section: Diagnostic Methodsmentioning

confidence: 99%

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Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience

Ahlander¹

2016

Linköping University Medical Dissertations

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Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown. Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients. Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies. Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV). Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality

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“…Previous multicenter, multivendor head-to-head comparison trials have suggested that perfusion MRI is a valuable alternative to SPECT for the detection of significant anatomic CAD, with superior diagnostic performance, especially in multivessel disease (17)(18)(19). In a recent metaanalysis, myocardial perfusion MRI demonstrated a sensitivity of 89% and specificity of 87% for the diagnosis of hemodynamically significant CAD using a X-ray coronary angiography with fractional flow reserve as a reference standard on a per-patient level, which are similar to those of PET (84% and 87%, respectively) and superior to those of SPECT (74% and 79%, respectively) (20).…”

Section: Assessment Of Myocardial Perfusionmentioning

confidence: 99%

Advanced Noninvasive Cardiac Imaging using Cardiac Magnetic Resonance Imaging in the Diagnosis and Evaluation of Coronary Artery Disease

Jung

Yoon

2017

Annals of Nuclear Cardiology

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Superior diagnostic performance of perfusion-cardiovascular magnetic resonance versus SPECT to detect coronary artery disease: The secondary endpoints of the multicenter multivendor MR-IMPACT II (Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary Artery Disease Trial)

Cited by 131 publications

References 29 publications

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Myocardial Segmentation of Area at Risk Based on Coronary Computed Tomography Angiography and Voronoi Diagram in Comparison with Magnetic Resonance Perfusion Imaging

Magnetic Resonance Imaging of the Heart : Image quality, measurement accuracy and patient experience

Advanced Noninvasive Cardiac Imaging using Cardiac Magnetic Resonance Imaging in the Diagnosis and Evaluation of Coronary Artery Disease

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