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Updated: Apr 19, 2026
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Published on: February 16, 2016
Comparison of the Diagnostic Performance of Four Quantitative Myocardial Perfusion Estimation Methods Used in Cardiac
John D Biglands1, Derek R Magee, Steven P Sourbron
1From the Division of Medical Physics (J.D.B., S.P.S.) and Division of Cardiovascular and Diabetes Research (S.P. J.P.G.), Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Worsley Building, Leeds LS2 9JT, England; Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, England (J.D.B.); School of Computing, University of Leeds, Leeds, England (D.R.M.); and Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland (A.R.).
Insights
Four methods for quantifying myocardial blood flow (MBF) using cardiac MRI showed similar diagnostic performance for detecting myocardial ischemia. The choice of tracer kinetic analysis method does not significantly impact the accuracy of these assessments.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Diagnostic Radiology
Background:
- Myocardial ischemia diagnosis relies on accurate quantification of myocardial perfusion.
- Magnetic Resonance (MR) imaging offers advanced capabilities for cardiac perfusion assessment.
- Various tracer kinetic analysis methods exist, necessitating a comparison of their diagnostic utility.
Purpose of the Study:
- To compare the diagnostic performance of four distinct tracer kinetic analysis methods.
- To evaluate the ability of these methods to quantify myocardial perfusion from MR imaging data.
- To determine their effectiveness in diagnosing myocardial ischemia.
Main Methods:
- Retrospective analysis of 50 patients with suspected ischemic heart disease from a clinical trial dataset.
- Estimation of quantitative myocardial blood flow (MBF) using four established tracer kinetic models (Fermi, uptake, one-compartment, model-independent deconvolution).
- Receiver operating characteristic (ROC) curve analysis comparing diagnostic performance against a reference standard for myocardial ischemia.
Main Results:
- All four methods demonstrated comparable diagnostic performance in identifying myocardial ischemia.
- Area under the ROC curve values for stress MBF and myocardial perfusion reserve (MPR) were high across all models.
- No statistically significant differences were found between the methods, with a minor exception favoring the Fermi model for MPR.
Conclusions:
- The diagnostic performance of quantitative myocardial perfusion estimates is not significantly influenced by the specific tracer kinetic analysis method employed.
- This suggests flexibility in choosing analysis techniques for MR imaging-based myocardial perfusion assessment.
- Accurate diagnosis of myocardial ischemia can be achieved irrespective of the chosen kinetic model.
Purpose:
To compare the diagnostic performance of four tracer kinetic analysis methods to quantify myocardial perfusion from magnetic resonance (MR) imaging cardiac perfusion data sets in terms of their ability to lead to the diagnosis of myocardial ischemia.
Materials And Methods:
The study was approved by the regional ethics committee, and all patients gave written consent. A representative sample of 50 patients with suspected ischemic heart disease was retrospectively selected from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease trial data set. Quantitative myocardial blood flow (MBF) was estimated from rest and adenosine stress MR imaging perfusion data sets by using four established methods. A matching diagnosis of both an inducible defect as assessed with single photon emission computed tomography and a luminal stenosis of 70% or more as assessed with quantitative x-ray angiography was used as the reference standard for the presence of myocardial ischemia. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis for each method, with stress MBF and myocardial perfusion reserve (MPR) serving as continuous measures.
Results:
Area under the ROC curve with stress MBF and MPR as the outcome measures, respectively, was 0.86 and 0.92 for the Fermi model, 0.85 and 0.87 for the uptake model, 0.85 and 0.80 for the one-compartment model, and 0.87 and 0.87 for model-independent deconvolution. There was no significant difference between any of the models or between MBF and MPR, except that the Fermi model outperformed the one-compartment model if MPR was used as the outcome measure (P = .02).
Conclusion:
Diagnostic performance of quantitative myocardial perfusion estimates is not affected by the tracer kinetic analysis method used.
