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Adenosine stress cardiovascular magnetic resonance with variable-density spiral pulse sequences accurately detects
Michael Salerno1, Angela Taylor2, Yang Yang2
1From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.). msalerno@virginia.edu.
Insights
This study shows that a new spiral sequence for adenosine stress cardiovascular magnetic resonance (CMR) accurately detects coronary artery disease. The technique provides high image quality with fewer artifacts, improving diagnostic performance.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- Adenosine stress cardiovascular magnetic resonance (CMR) perfusion imaging is crucial for diagnosing coronary artery disease.
- Motion-induced dark-rim artifacts can mimic true perfusion abnormalities, limiting diagnostic accuracy.
- A novel high-resolution variable-density spiral pulse sequence with enhanced density compensation aims to reduce these artifacts.
Purpose of the Study:
- To evaluate the clinical performance of adenosine stress CMR using a new spiral perfusion sequence.
- To assess the sequence's ability to detect obstructive coronary artery disease.
- To determine image quality and artifact reduction capabilities.
Main Methods:
- Adenosine stress CMR perfusion imaging was performed on 41 patients with chest pain using a Siemens 1.5-T scanner.
- A saturation recovery interleaved variable-density spiral pulse sequence was employed during contrast agent injection.
- Image analysis included assessment of perfusion abnormalities and image quality by blinded reviewers, compared against quantitative coronary angiography (QCA).
Main Results:
- The prevalence of obstructive coronary artery disease (>50% stenosis) by QCA was 68%.
- The spiral sequence achieved high diagnostic accuracy: 89% sensitivity, 85% specificity, and 88% overall accuracy.
- Excellent average image quality (4.4/5) was reported with minimal dark-rim artifacts, and good inter-reader reliability (κ=0.67).
Conclusions:
- Spiral adenosine stress CMR demonstrates high diagnostic accuracy for obstructive coronary artery disease.
- The novel sequence provides excellent image quality and significantly reduces dark-rim artifacts.
- This technique offers a reliable method for diagnosing coronary artery disease with improved CMR imaging.
Background:
Adenosine stress cardiovascular magnetic resonance perfusion imaging can be limited by motion-induced dark-rim artifacts, which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral pulse sequence with a novel density compensation strategy has been shown to reduce dark-rim artifacts in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress cardiovascular magnetic resonance using this new perfusion sequence to detect obstructive coronary artery disease.
Methods And Results:
Cardiovascular magnetic resonance perfusion imaging was performed during adenosine stress (140 microg/kg per minute) and at rest on a Siemens 1.5-T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography. Perfusion images were acquired during injection of 0.1 mmol/kg Gadolinium-diethylenetriaminepentacetate at 3 short-axis locations using a saturation recovery interleaved variable-density spiral pulse sequence. Significant stenosis was defined as >50% by quantitative coronary angiography. Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5-point scale (1 [poor] to 5 [excellent]). The prevalence of obstructive coronary artery disease by quantitative coronary angiography was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88%, respectively, with a positive predictive value and negative predictive value of 93% and 79%, respectively. The average image quality score was 4.4±0.7, with only 1 study with more than mild dark-rim artifacts. There was good inter-reader reliability with a κ statistic of 0.67.
Conclusions:
Spiral adenosine stress cardiovascular magnetic resonance results in high diagnostic accuracy for the detection of obstructive coronary artery disease with excellent image quality and minimal dark-rim artifacts.
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