Magnetic resonance myocardial perfusion imaging at 3.0 Tesla for the identification of myocardial ischaemia: comparison with coronary catheter angiography and fractional flow reserve measurements

• Published in: European heart journal cardiovascular imaging 2013-12, Vol.14 (12), p.1174-1180
• Main Authors: Ebersberger, Ullrich, Makowski, Marcus R, Schoepf, U Joseph, Platz, Ulrich, Schmidtler, Fabian, Rose, Johanna, Kessel, Anne, Roth, Patricia, Antoni, Diethmar, Schnackenburg, Bernhard, Helmberger, Thomas, Rieber, Johannes, Hoffmann, Ellen, Leber, Alexander W
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Catheterization - methods; Cohort Studies; Coronary Angiography - methods; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Female; Follow-Up Studies; Fractional Flow Reserve, Myocardial; Humans; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - diagnostic imaging; Myocardial Perfusion Imaging - methods; Observer Variation; Retrospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Severity of Illness Index
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jet074

To assess image quality and diagnostic performance of 3.0 Tesla (3T) cardiac magnetic resonance (CMR) myocardial perfusion imaging with a dual radiofrequency source to detect functional relevant coronary artery disease (CAD), using coronary angiography and invasive pressure-derived fractional flow reserve (FFR) as reference standard. We included 116 patients with suspected or known CAD, who underwent 3T adenosine myocardial perfusion CMR (resolution 2.97 × 2.97 mm) and coronary angiography plus FFR measurements in intermediate lesions. Image quality of myocardial perfusion CMR was graded on a 4-point scale (1 = poor to 4 = excellent). Diagnostic accuracy was assessed by ROC analyses using a 16-myocardial segment-based summed perfusion score (0 = normal to 3 = transmural perfusion defect) and by determining sensitivity, specificity, positive and negative predictive value on the coronary vessel territory and the patient level. Diagnostic image quality was achieved for all stress myocardial perfusion CMR studies with an average quality score of 2.5, 3.1, and 3.0 for LAD, LCX, and RCA territories. The ability of the myocardial perfusion CMR perfusion score to detect significant coronary artery stenosis yielded an area under the curve of 0.93 on ROC analysis. Values for sensitivity, specificity, positive and negative predictive value on a vessel territory level and the patient level were 89, 95, 87, 96% and 85, 87, 77, 92%, respectively. In patients with suspected or known significant CAD, 3T myocardial perfusion CMR with standard perfusion protocols provides consistently high image quality and an excellent diagnostic performance.