High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k–t SENSE

• Published in: International journal of cardiology 2012-07, Vol.158 (3), p.411-416
• Main Authors: Gebker, R, Jahnke, C, Manka, R, Frick, M, Hucko, T, Kozerke, S, Schnackenburg, B, Fleck, E, Paetsch, I
• Format: Article
• Language: English
• Subjects: Aged; Atropine - administration & dosage; Biological and medical sciences; Cardiac Imaging Techniques - methods; Cardiac magnetic resonance; Cardiology. Vascular system; Cardiotonic Agents - administration & dosage; Cardiovascular; Coronary Angiography; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary heart disease; Dobutamine - administration & dosage; Exercise Test - methods; Female; Heart; Humans; Ischemia; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Muscarinic Antagonists - administration & dosage; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - pathology; Myocardial perfusion; Prospective Studies; Sensitivity and Specificity; Wall motion
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.01.060

Abstract Purpose To prospectively evaluate the feasibility and diagnostic accuracy of high spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR) for the detection of coronary artery disease (CAD). Methods and results DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 78 patients prior to clinically indicated invasive coronary angiography. For DSMR-perfusion an in-plane spatial resolution of 1.5 × 1.5 mm2 was attained by using 8 × k -space and time sensitivity encoding ( k–t SENSE). Image quality and extent of artifacts during perfusion imaging were evaluated. Wall motion and perfusion data were interpreted sequentially. Significant CAD (stenosis ≥ 70%) was present in 52 patients and involved 86 coronary territories. One patient did not reach target heart rate despite maximum infusion of dobutamine/atropine. Two studies (3%) were non-diagnostic due k–t SENSE related artifacts resulting from insufficient breathhold capability. Overall image quality was good. Dark-rim artifacts were limited to the endocardial border at a mean width of 1.8 mm. The addition of DSMR-perfusion to DSMR-wall motion data improved sensitivity for the detection of CAD (92% vs. 81%, P = 0.03) and accurate determination of disease extent (85% vs. 66% of territories, P < 0.001). There were no significant differences between DSMR-perfusion and DSRM-wall motion regarding overall specificity (83% vs. 87%, P = 1) and accuracy (89% vs. 83%, P = 0.13). Conclusion High spatial resolution DSMR-perfusion imaging at maximum stress level was feasible, improved sensitivity over DSMR-wall motion for the detection of CAD and allowed an accurate determination of disease extent. Specificity of DSMR-perfusion with k–t SENSE improved compared to prior studies using lower spatial resolution.