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[Evaluation of myocardial perfusion reserve in patients with CAD using contrast-enhanced MRI: a comparison between
M Schmitt1, O K Mohrs, S E Petersen
1Klinik und Poliklinik für Radiologie, Johannes Gutenberg-Universität, Mainz, Germany. schmitt@radiologie.klinik.uni-mainz.de
Insights
The normalized up-slope method and MMID 4 quantification are more sensitive for detecting reduced myocardial perfusion reserve (MPR) in coronary artery disease (CAD) patients. These methods better differentiate ischemic from remote myocardium compared to unnormalized up-slope analysis.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- Assessing myocardial perfusion reserve (MPR) is crucial for diagnosing coronary artery disease (CAD).
- Semiquantitative and quantitative methods are used to evaluate myocardial blood flow (MBF).
- Comparing the diagnostic accuracy of different MPR assessment techniques is essential.
Purpose of the Study:
- To compare two semiquantitative methods and one quantitative method for assessing MPR in CAD patients.
- To evaluate the sensitivity of different methods in differentiating ischemic from remote myocardium.
Main Methods:
- Used ECG-gated Saturation Recovery Turbo FLASH MRI with Gd-DTPA contrast agent.
- Measured myocardial blood flow (MBF) at rest and during adenosine-induced hyperemia in 9 CAD patients.
- Calculated MPR using original up-slopes, normalized up-slopes, and the MMID 4 quantitative model.
Main Results:
- All methods showed reduced MPR in regions with stenoses >/= 70% compared to remote regions.
- The MMID 4 quantitative method and the normalized up-slope method demonstrated statistically significant differences between severely ischemic and remote myocardium.
- Unnormalized up-slope analysis showed less significant differentiation.
Conclusions:
- The normalized up-slope method and MMID 4 quantification are more sensitive for differentiating ischemic from remote myocardium.
- These advanced methods offer improved diagnostic capability for MPR assessment in CAD.
Objective:
Comparison between two semiquantitative methods and a quantitative evaluation of myocardial blood flow (MBF) for assessment of myocardial perfusion reserve (MPR) in patients with CAD.
Material And Methods:
9 patients with coronary stenoses > 50 % were examined with an ECG-gated Saturation Recovery Turbo FLASH sequence by using Gd-DTPA as contrast agent (CA). The entive measurements were performed both during rest and hyperemia induced by adenosine. The up-slopes of the signal-time S(t) curves in the myocardium and left ventricular (LV) cavity were evaluated by a linear fit. MPR was calculated from the original up-slopes of the myocardial S(t) curves and from the up-slopes, which were normalized to the up-slopes of the LV S(t) curves, respectively. For quantification of MBF values, the mathematical model MMID 4 was used and MPR was evaluated from the MBF values.
Results:
With all tested methods, MPR was reduced in myocardial regions subtended by arteries with stenoses >/= 70 % compared with remote regions. With MMID 4 and the normalized up-slope method, differences between severe ischemic and remote regions were statistically significant.
Conclusion:
The up-slope method with normalization and quantification with MMID 4 are more sensitive methods to differentiate between remote and ischemic myocardium than the up-slope method without normalization.
