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Updated: Apr 13, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance
1Department of Internal Medicine/Cardiology, German Heart Institute Berlin and Charité, Campus Virchow, Humboldt University, Berlin, Germany.
Insights
Cardiovascular MR accurately detects coronary artery stenosis by assessing myocardial perfusion reserve. This noninvasive technique is highly sensitive and specific for identifying significant blockages in coronary arteries.
Area of Science:
- Cardiovascular Magnetic Resonance (CMR) Imaging
- Noninvasive Cardiac Diagnostics
- Coronary Artery Disease Assessment
Background:
- Myocardial perfusion reserve is crucial for assessing coronary artery disease (CAD).
- Cardiovascular magnetic resonance (CMR) offers a noninvasive method for evaluating myocardial perfusion reserve.
- The diagnostic accuracy of CMR for detecting significant coronary artery stenosis requires validation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of cardiovascular MR in detecting significant coronary artery stenosis.
- To determine the effectiveness of noninvasive myocardial perfusion reserve assessment using CMR.
- To compare CMR findings with coronary angiography in patients with suspected CAD.
Main Methods:
- Utilized first-pass gadolinium-DTPA (diethylenetriamine pentaacetic acid) bolus tracking during CMR.
- Administered dipyridamole infusion to pharmacologically stress myocardial perfusion.
- Analyzed signal intensity-time curves, calculating the upslope via linear fit to determine myocardial perfusion reserve.
- Defined a cutoff value for differentiating between normal and ischemic myocardial segments.
Main Results:
- CMR demonstrated a significant difference in myocardial perfusion reserve between ischemic and normal segments (1.08 vs. 2.33; P<0.001).
- A cutoff value of 1.5 was established for diagnosing coronary artery stenosis.
- Prospective analysis showed 90% sensitivity, 83% specificity, and 87% overall diagnostic accuracy for detecting > or =75% coronary artery stenosis.
- Low interobserver and intraobserver variability (r=0.96 and 0.99) confirmed reproducibility.
Conclusions:
- CMR first-pass perfusion imaging provides high diagnostic accuracy for detecting coronary artery disease.
- Myocardial perfusion reserve can be reliably quantified using a linear fit of the upslope of signal intensity-time curves.
- This noninvasive CMR technique is easily and reproducibly performed.
Background:
Myocardial perfusion reserve can be noninvasively assessed with cardiovascular MR. In this study, the diagnostic accuracy of this technique for the detection of significant coronary artery stenosis was evaluated.
Methods And Results:
In 15 patients with single-vessel coronary artery disease and 5 patients without significant coronary artery disease, the signal intensity-time curves of the first pass of a gadolinium-DTPA bolus injected through a central vein catheter were evaluated before and after dipyridamole infusion to validate the technique. A linear fit was used to determine the upslope, and a cutoff value for the differentiation between the myocardium supplied by stenotic and nonstenotic coronary arteries was defined. The diagnostic accuracy was then examined prospectively in 34 patients with coronary artery disease and was compared with coronary angiography. A significant difference in myocardial perfusion reserve between ischemic and normal myocardial segments (1.08+/-0.23 and 2.33+/-0.41; P<0.001) was found that resulted in a cutoff value of 1.5 (mean minus 2 SD of normal segments). In the prospective analysis, sensitivity, specificity, and diagnostic accuracy for the detection of coronary artery stenosis (> or =75%) were 90%, 83%, and 87%, respectively. Interobserver and intraobserver variabilities for the linear fit were low (r=0.96 and 0.99).
Conclusions:
MR first-pass perfusion measurements yielded a high diagnostic accuracy for the detection of coronary artery disease. Myocardial perfusion reserve can be easily and reproducibly determined by a linear fit of the upslope of the signal intensity-time curves.
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