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Semi-Quantitative Versus Visual Analysis of Adenosine Perfusion Magnetic Resonance Imaging in Intermediate-Grade
Olivier Ghekiere1,2,3, Jean-Nicolas Dacher4, Willem Dewilde5
1Department of Radiology, Jessa Ziekenhuis, Stadsomvaart 11, B-3500 Hasselt, BE.
Background:
To evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging (MRI) to determine fractional flow reserve (FFR) ≤ 0.80 intermediate-grade coronary stenoses as compared to visual analysis.
Methods:
Forty-six patients (mean age 61 ± 9 years; 33 males) with 49 intermediate-grade stenoses (59 ± 7.6%; range, 42-70% minimal diameter reduction) underwent adenosine perfusion MRI and FFR measurement within four months in this retrospective study. MRI was visually assessed by two experienced readers twice with one-year interval, the second time with the knowledge of the diseased artery. The stress subendocardial myocardial enhancement maximal upslope was evaluated distal to the coronary stenosis (=RISK) and divided by the same value in remote myocardium supplied by normal arteries (=REMOTE) to obtain the relative myocardial perfusion index (RMPI).
Results:
The average FFR value was 0.84 ± 0.09 and 15/49(31%) intermediate-grade stenoses were FFR ≤ 0.80. The kappa-values for interobserver agreement assessing inducible perfusion defects on visual readings was 0.20 on the first reading and increased to 0.62 with the knowledge of the stenosis location. Consensus readings had a diagnostic accuracy of 82%(40/49) in identifying FFR ≤ 0.80 stenoses on both blinded and unblinded readings with regards to the knowledge of the stenosis location. Meanwhile, stress subendocardial RMPI had higher accuracy (43/49[88%]) than visual readings to predict FFR ≤ 0.80 stenoses, using a cutoff value of 0.84.
Conclusion:
By assessing perfusion changes in remote myocardium, semi-quantitative MRI analysis using stress subendocardial RMPI can provide an equal or more accurate alternative to visual analysis in identifying FFR ≤ 0.80 intermediate-grade stenoses. Larger cohorts of patients are required to validate this approach.
Insights
Semi-quantitative adenosine perfusion magnetic resonance imaging (MRI) accurately identifies significant coronary artery blockages. This method offers a valuable alternative to visual analysis for diagnosing intermediate-grade stenoses, potentially improving patient care.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Radiology
Background:
- Assessing intermediate-grade coronary stenoses is crucial for guiding treatment decisions.
- Fractional flow reserve (FFR) is the gold standard for determining the functional significance of coronary stenoses.
- Current diagnostic methods for intermediate-grade stenoses have limitations.
Purpose of the Study:
- To evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging (MRI).
- To compare the accuracy of semi-quantitative MRI with visual analysis in identifying significant coronary stenoses (FFR ≤ 0.80).
Main Methods:
- Retrospective study of 46 patients with 49 intermediate-grade coronary stenoses.
- Adenosine perfusion MRI and FFR measurements were performed.
- Semi-quantitative analysis involved calculating the relative myocardial perfusion index (RMPI) from stress subendocardial enhancement.
- Visual assessment of MRI by two experienced readers was performed twice.
Main Results:
- Semi-quantitative MRI analysis (RMPI) achieved 88% accuracy in identifying stenoses with FFR ≤ 0.80.
- Visual analysis had 82% accuracy, with improved interobserver agreement when stenosis location was known.
- RMPI demonstrated higher diagnostic accuracy than visual assessment.
Conclusions:
- Semi-quantitative adenosine perfusion MRI (RMPI) is an accurate method for diagnosing significant intermediate-grade coronary stenoses.
- This technique may offer an improved alternative to visual MRI analysis.
- Further validation in larger patient cohorts is warranted.
