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Systolic versus diastolic acquisition in myocardial perfusion MR imaging
Manish Motwani1, Timothy A Fairbairn, Abdulghani Larghat
1Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS2 9JT, England.
Insights
Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) are higher during diastole than systole. Both phases showed similar diagnostic accuracy for detecting coronary artery disease (CAD) using magnetic resonance imaging.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Cardiac MRI
Background:
- Assessing myocardial blood flow (MBF) is crucial for diagnosing coronary artery disease (CAD).
- Magnetic resonance (MR) imaging offers a non-invasive method to evaluate MBF and myocardial perfusion reserve (MPR).
- The influence of systolic versus diastolic phases on MBF and MPR accuracy in CAD detection requires clarification.
Purpose of the Study:
- To compare myocardial blood flow (MBF) measurements during systole and diastole.
- To evaluate the diagnostic accuracy of both systolic and diastolic phases for detecting coronary artery disease (CAD).
- To assess myocardial perfusion reserve (MPR) in systole versus diastole.
Main Methods:
- Forty patients with suspected CAD underwent stress-rest perfusion MR imaging at 1.5 T.
- Images were acquired simultaneously at end-systole and mid-diastole.
- MBF and MPR were calculated for myocardial segments, and diagnostic accuracy was determined using ROC analysis.
Main Results:
- Stress MBF and MPR were significantly greater in diastole compared to systole across all myocardial segments (normal, remote, and stenosis-dependent).
- Resting MBF showed no significant difference between systolic and diastolic phases.
- The diagnostic accuracy for CAD detection was similar for both diastolic and systolic phases (AUC 0.79 vs. 0.82, P = .30).
Conclusions:
- Diastolic phase measurements of stress MBF and MPR are higher than systolic measurements in patients with and without CAD.
- Both systolic and diastolic phases demonstrate comparable diagnostic accuracy for identifying CAD via MR perfusion imaging.
- Findings may inform other dynamic perfusion imaging techniques like CT and echocardiography.
Purpose:
To compare myocardial blood flow (MBF) at systole and diastole and determine the diagnostic accuracy of both phases in patients suspected of having coronary artery disease (CAD).
Materials And Methods:
The study was approved by the regional ethics committee, and all patients gave written informed consent. After coronary angiography, 40 patients (27 men; mean age, 64 years ± 8) underwent stress-rest perfusion magnetic resonance (MR) imaging at 1.5 T, with images aquired simultaneously at end systole and middiastole. Patients were classified as having CAD (stenosis .70%) or no significant CAD. In patients with CAD, myocardial segments were classified as stenosis-dependent (downstream of significant stenosis) or remote. MBF and myocardial perfusion reserve (MPR) were calculated for each segment, and mean values in each phase were compared with paired t tests. The diagnostic accuracy of each phase was determined with receiver operating characteristic (ROC) analysis.
Results:
Twenty-one of the 40 patients (53%) had CAD. Resting MBF was similar in both phases for patients with and patients without CAD (P > .05). Stress MBF was greater in diastole than systole in normal, remote, and stenosis-dependent segments (3.75 mL/g/min ± 1.50 vs 3.15 mL/g/min ± 1.10, respectively, for normal segments; 2.75 mL/g/min ± 1.20 vs 2.38 mL/g/min ± 0.99, respectively, for remote segments; 2.49 mL/g/min ± 1.07 vs 2.23 mL/g/min ± 0.90, respectively, for stenosis-dependent segments; P <.01). MPR was greater in diastole than systole in all segment groups (P < .05). The diagnostic accuracies at diastole and systole were similar (area under the ROC curve = 0.79 and 0.82, respectively; P = .30).
Conclusion:
Myocardial perfusion MR estimates of stress MBF and MPR were greater in diastole than systole in patients with and patients without CAD. However, both phases had similar diagnostic accuracy. These observations may be relevant to other dynamic perfusion methods, including computed tomography and echocardiography.
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