Value of Relative Myocardial Perfusion at MRI for Fractional Flow Reserve–Defined Ischemia: A Pilot Study

Ghekiere, Olivier; Dacher, Jean‐Nicolas; Dewilde, Willem; Mancini, Isabelle; Cools, Wilfried; Vanhoenacker, Peter; Dendale, Paul; Lancellotti, Patrizio; Roos, Albert de; Nchimi, Alain

doi:10.2214/ajr.18.20469

Cited by 5 publications

(14 citation statements)

References 37 publications

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“…In this setting, the reported stress subendocardial RMPI [12] provides a simpli ed and more useful semi-quantitative parameter for clinical practice, with a high diagnostic accuracy to determine FFR≤0.80 intermediate-grade stenoses, in line with those of previous meta-analyses, including mainly semi-quantitative and quantitative MRI analyses [10]. This approach has also been reported in stress dynamic computed tomography perfusion showing better accuracy to identify ow-limiting stenoses than the myocardial blood ow in the area-at-risk [24].…”

Section: Patient and Intermediate-grade Coronary Stenoses Characterismentioning

confidence: 96%

“…This study protocol was approved by the local institutional ethics committee, and patients provided written informed consent. Between 2010 and 2013, consecutive patients with an intermediate-grade stenosis on computed tomography angiography involving one or two major epicardial coronary vessels >1.5mm in diameter were eligible for a study requiring both catheter coronary angiography with FFR measurements and adenosine perfusion MRI within 4 months as previously reported [12]. MRI examinations were performed on a 1.5T MR scanner (Avanto, Siemens Healthineers), as previously reported [12].…”

Section: Patients and Study Protocolmentioning

confidence: 99%

“…Between 2010 and 2013, consecutive patients with an intermediate-grade stenosis on computed tomography angiography involving one or two major epicardial coronary vessels >1.5mm in diameter were eligible for a study requiring both catheter coronary angiography with FFR measurements and adenosine perfusion MRI within 4 months as previously reported [12]. MRI examinations were performed on a 1.5T MR scanner (Avanto, Siemens Healthineers), as previously reported [12]. In short, the examination consisted in performing stress and resting perfusion on dynamic contrast-enhancement imaging (each using 0.1 mmol/kg Gadodiamide, Omniscan Ò ), and late-gadolinium enhancement (LGE) in the same three short-axis positions (see the supplementary materials for more details).…”

Section: Patients and Study Protocolmentioning

confidence: 99%

“…As previously described [12], equally divided subendocardial (END) and subepicardial (EPI) regions of interest and timesignal intensity curves were obtained during adenosine stress in the myocardium distal to the stenosis (=RISK). When the RISK area involved more than one segment of the left ventricle representation, the myocardial segment with the greatest lateral and transmural extent of the perfusion defect was used for further measurements.…”

Section: Semi-quantitative Analysismentioning

confidence: 99%

“…As this semi-quantitative index better correlated with the FFR value than the uncorrected enhancement upslope [12], we hypothesized that RMPI could provide high diagnostic accuracy for the detection of FFR-altered intermediate coronary stenoses. Accordingly, the aim of this study was to evaluate the diagnostic accuracy of stress RMPI to determine FFR≤0.80 intermediate-grade coronary stenoses as compared to individual visual analysis.…”

Section: Introductionmentioning

confidence: 99%

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Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

Ghekiere

Dacher

Dewilde

et al. 2021

Preprint

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PurposeTo evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging(MRI) to determine fractional flow reserve(FFR)≤0.80 intermediate-grade coronary stenoses as compared to visual analysis.Methods Forty-six patients (mean age 61±9 years;33 males) with 49 intermediate-grade stenoses underwent adenosine perfusion MRI and FFR measurement within 4 months between 2010 and 2013. Retrospective interpretation of all prospectively acquired data was performed. MRI was visually assessed by 2 experienced readers twice with one-year interval, the second time with the knowledge of the diseased artery. All myocardial enhancement maximal upslopes were evaluated distal to the coronary stenosis (=RISK) and in remote myocardium supplied by normal arteries (=REMOTE); stress subendocardial relative myocardial perfusion index (RMPI; RISK/REMOTE upslopes) was assessed in predicting FFR≤0.80 stenoses. Deep learning boosting models including all RISK and REMOTE upslopes were fitted to confirm the added value of accounting for perfusion changes in remote myocardium for FFR prediction. Results The average FFR value was 0.84±0.09 and 15/49 (31%) stenoses were FFR≤0.80. Both readers had moderate accuracy (range: 36/49(73%)-38/49(78%)) in predicting FFR≤0.80 stenoses, even with the knowledge of the stenosis location. At a cutoff value of 0.84, stress subendocardial RMPI had higher accuracy (43/49(88%)) than individual visual readings to predict FFR≤0.80 stenoses. The best FFR prediction using the boosting model occurred when accounting for REMOTE myocardial perfusion parameters, leading to diagnostic accuracy of 44/49(90%) for FFR≤0.80. Conclusion Semi-quantitative adenosine perfusion MRI accounting for stress perfusion in remote myocardium predicts FFR≤0.80 intermediate-grade coronary stenoses with a higher accuracy than individual visual analysis.

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Section: Patient and Intermediate-grade Coronary Stenoses Characterismentioning

confidence: 96%

Section: Patients and Study Protocolmentioning

confidence: 99%

Section: Patients and Study Protocolmentioning

confidence: 99%

Section: Semi-quantitative Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

Ghekiere

Dacher

Dewilde

et al. 2021

Preprint

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Duration of adenosine-induced myocardial hyperaemia: insights from quantitative 13N-ammonia positron emission tomography myocardial perfusion imaging

Garefa,

Sager,

Heiniger

et al. 2024

European Heart Journal - Cardiovascular Imaging

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Aims To assess the impact of adenosine on quantitative myocardial blood flow (MBF) in a rapid stress-rest protocol compared to a rest-stress protocol using 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) and to gain insights into the time dependency of such effects. Methods and results Quantitative MBF at rest (rMBF), during adenosine-induced stress (sMBF) and myocardial flow reserve (MFR) were obtained from 331 retrospectively identified patients who underwent 13N-ammonia PET-MPI for suspected chronic coronary syndrome and who all exhibited no perfusion defects. Of these, 146 (44.1%) underwent a rapid stress-rest protocol with a time interval (Δtstress-rest) of 20 ± 4 minutes between adenosine infusion offset and rest-imaging, as per clinical routine. The remaining 185 (55.9%) patients underwent a rest-stress protocol and served as the reference. Groups did not differ regarding demographics, risk factors, medication, left ventricular function, and calcium scores. rMBF was significantly higher in the stress-rest vs. the rest-stress group (0.80 [IQR 0.66-1.00] vs. 0.70 [0.58-0.83] ml·min-1·g-1, p < 0.001) and, as sMBF was identical between groups (2.52 [2.20-2.96] vs. 2.50 [1.96-3.11], p = 0.347), MFR was significantly lower in the stress-rest group (3.07 [2.43-3.88] vs. 3.50 [2.63-4.10], p < 0.001). There was a weak correlation between Δtstress-rest and rMBF (r = -0.259, p = 0.002) and between Δtstress-rest and MFR (r = 0.163, p = 0.049), and the proportion of patients with abnormally high rMBF was significantly decreasing with increasing Δtstress-rest. Conclusions Intravenously applied adenosine induces a long-lasting hyperemic effect on the myocardium. Consequently, rapid stress-rest protocols could lead to an overestimation of rMBF and an underestimation of MFR.

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Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods: Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (Rev-Man) 5.3 and Stata software. Results: A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions: SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cutoff of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.

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Value of Relative Myocardial Perfusion at MRI for Fractional Flow Reserve–Defined Ischemia: A Pilot Study

Cited by 5 publications

References 37 publications

Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

Duration of adenosine-induced myocardial hyperaemia: insights from quantitative 13N-ammonia positron emission tomography myocardial perfusion imaging

Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis

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