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Contrast-enhanced cardiac MR imaging in the detection of reduced coronary flow velocity reserve
Achim A Barmeyer1, Alexander Stork, Kai Muellerleile
1Clinic of Cardiology/Angiology, Heart Center, University Hospital Hamburg-Eppendorf, Martini-strasse 52, 20246 Hamburg, Germany. barmeyer@uke.uni-hamburg.de
Insights
Contrast-enhanced cardiac MRI accurately detects impaired coronary flow velocity reserve (CFR). Subendocardial analysis offers higher diagnostic accuracy than transmural analysis for identifying reduced CFR.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Diagnostic Radiology
Background:
- Coronary artery disease (CAD) diagnosis relies on assessing coronary flow velocity reserve (CFR).
- Contrast-enhanced cardiac magnetic resonance (MR) imaging offers a non-invasive method to evaluate myocardial perfusion.
- Accurate assessment of CFR is crucial for guiding treatment decisions in patients with suspected or known CAD.
Purpose of the Study:
- To prospectively evaluate the accuracy of contrast-enhanced cardiac MR imaging in determining impaired CFR.
- To compare the diagnostic performance of subendocardial versus transmural myocardial perfusion reserve index (MPRI) measurements.
- To establish an optimal MPRI cutoff value for detecting reduced CFR using Doppler flow measurement as the reference standard.
Main Methods:
- Contrast-enhanced cardiac MR imaging was performed on 35 patients.
- Myocardial perfusion reserve index (MPRI) was calculated for transmural and subendocardial segments.
- MPRI values were correlated with invasive CFR measurements obtained by Doppler flowmetry.
- Receiver operating characteristic (ROC) analysis was used to determine diagnostic accuracy and optimal cutoff values.
Main Results:
- A significant linear correlation was observed between MPRI and CFR (r = 0.44, P < .05).
- Subendocardial MPRI measurements demonstrated higher accuracy in detecting reduced CFR compared to transmural measurements.
- The mean subendocardial MPRI of the three lowest segments achieved an area under the ROC curve of 0.85 (sensitivity 84%, specificity 75%) for detecting CFR < 2.00 with a cutoff of 1.21.
Conclusions:
- Contrast-enhanced cardiac MR imaging, particularly with subendocardial analysis, is an accurate method for assessing CFR.
- Subendocardial MPRI analysis provides superior diagnostic performance over transmural analysis for detecting impaired coronary flow.
- This technique can aid in the non-invasive diagnosis of coronary artery disease.
Purpose:
To prospectively evaluate the accuracy of contrast material-enhanced cardiac magnetic resonance (MR) imaging for determining impaired coronary flow velocity reserve (CFR) by using Doppler flow measurement as the reference standard.
Materials And Methods:
The study was approved by the institutional ethics committee, and all patients gave written informed consent. Eligible patients underwent contrast-enhanced cardiac MR imaging and invasive measurement of CFR. For contrast-enhanced MR imaging, a three-section single-shot saturation recovery gradient-recalled echo sequence with steady-state free precession was used. Sections were divided into six segments. For each segment, a transmural and subendocardial myocardial perfusion reserve index (MPRI) was calculated by using the upslope of the signal intensity-time curve during the first pass of contrast material at rest and during adenosine infusion (140 microg per kilogram body weight per minute). MPRIs of vascular regions were compared with the corresponding CFR. Receiver operating characteristic (ROC) analysis was performed to find the number of segments needed for best diagnostic accuracy of MPRI and to find a cutoff value for MPRI in the detection of a reduced CFR.
Results:
Thirty-five patients were evaluated (male-to-female ratio, 27:8; mean age +/- standard deviation, 63.5 years +/- 8.2; mean body mass index, 28.8 kg/m(2) +/- 3.8), and 43 vascular regions were analyzed. A linear correlation was found between the MPRI and CFR (r = 0.44, P < .05). The MPRI was significantly lower in vascular regions with a CFR of less than 2.00 than in regions with a CFR of 2.00 or greater (P < .05). Detection of a CFR of less than 2.00 was more accurate with subendocardial MPRI measurements than with transmural measurements. The mean subendocardial MPRI of the segments with the three lowest MPRIs of a vascular region showed the best diagnostic performance in the detection of a CFR of less than 2.00 (area under the ROC curve, 0.85; sensitivity, 84%; specificity, 75%) by using a cutoff value of 1.21.
Conclusion:
The diagnostic accuracy of subendocardial perfusion analysis in contrast-enhanced cardiac MR imaging is higher than that of transmural analysis.
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