First-pass myocardial perfusion MRI with vasodilator stress permits noninvasive detection of flow-limiting stenoses in the coronary arteries. Myocardial perfusion MRI with a steady state sequence can provide improved contrast noise and reduced artifact in comparison with conventional perfusion MR sequences. The purposes of this multicenter study was to determine the diagnostic accuracy of rest and stress perfusion MRI acquired with a steady state sequence in detecting significant obstructive coronary artery disease.
METHOD AND MATERIALS
This prospective trial was performed at 3 clinical sites. A total of 50 patients with suspected coronary artery disease were evaluated with a 1.5T MR system. First-pass contrast enhanced perfusion MR images were acquired during pharmacological stress and in the resting state by using a saturation recovery prepared steady state sequence(FIESTA). Catheter coronary angiography was performed in all patients within 2 weeks of MR study. MR images were reviewed by 3 independent blinded readers. Luminal diameter narrowing on coronary angiography was quantified by another independent observer.
RESULTS
Significant luminal narrowing (≥50%) was observed on coronary angiography in 36 (72%) of 50 patients. The averaged sensitivity of rest-stress perfusion MRI for detecting patients having significant stenosis in at least one coronary artery was 87.0±3.2% (range 83.3-88.9%). The averaged area under ROC curve was 0.827±0.010 (0.815-0.834) for detecting significant stenosis in the individual coronary artery. The averaged sensitivity and specificity for detecting significant stenosis in the individual coronary artery was 76.0±4.5%(72.1-80.9%) and 83.3±3.1%(80.5-86.6%), respectively, with good interobserver agreements (mean κ=0.566±0.049:Cohen's κ statistics).
CONCLUSION
Stress myocardial perfusion MRI using steady state acquisition provides accurate detection of flow limiting stenoses in the coronary arteries with good interobserver agreements. Comparison of rest and stress perfusion MR images is essential to differentiate subendocardial ischemia from artifact and to obtain high diagnostic accuracy.
DISCLOSURE
T.K.F.: Employee of GE Medical Systems A.N.: Employee of GE Yokogawa Medical Systems
PURPOSE
First-pass myocardial perfusion MRI with vasodilator stress permits noninvasive detection of flow-limiting stenoses in the coronary arteries. Myocardial perfusion MRI with a steady state sequence can provide improved contrast noise and reduced artifact in comparison with conventional perfusion MR sequences. The purposes of this multicenter study was to determine the diagnostic accuracy of rest and stress perfusion MRI acquired with a steady state sequence in detecting significant obstructive coronary artery disease.
METHOD AND MATERIALS
This prospective trial was performed at 3 clinical sites. A total of 50 patients with suspected coronary artery disease were evaluated with a 1.5T MR system. First-pass contrast enhanced perfusion MR images were acquired during pharmacological stress and in the resting state by using a saturation recovery prepared steady state sequence(FIESTA). Catheter coronary angiography was performed in all patients within 2 weeks of MR study. MR images were reviewed by 3 independent blinded readers. Luminal diameter narrowing on coronary angiography was quantified by another independent observer.
RESULTS
Significant luminal narrowing (≥50%) was observed on coronary angiography in 36 (72%) of 50 patients. The averaged sensitivity of rest-stress perfusion MRI for detecting patients having significant stenosis in at least one coronary artery was 87.0±3.2% (range 83.3-88.9%). The averaged area under ROC curve was 0.827±0.010 (0.815-0.834) for detecting significant stenosis in the individual coronary artery. The averaged sensitivity and specificity for detecting significant stenosis in the individual coronary artery was 76.0±4.5%(72.1-80.9%) and 83.3±3.1%(80.5-86.6%), respectively, with good interobserver agreements (mean κ=0.566±0.049:Cohen's κ statistics).
CONCLUSION
Stress myocardial perfusion MRI using steady state acquisition provides accurate detection of flow limiting stenoses in the coronary arteries with good interobserver agreements. Comparison of rest and stress perfusion MR images is essential to differentiate subendocardial ischemia from artifact and to obtain high diagnostic accuracy.
DISCLOSURE
T.K.F.: Employee of GE Medical Systems A.N.: Employee of GE Yokogawa Medical Systems
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