Quantitative myocardial perfusion in coronary artery disease: A perfusion mapping study. Issue 3 (25th January 2019)

• Record Type: Journal Article
• Authors: Knott, Kristopher D.; Camaioni, Claudia; Ramasamy, Anantharaman; Augusto, Joao A.; Bhuva, Anish N.; Xue, Hui; Manisty, Charlotte; Hughes, Rebecca K.; Brown, Louise A.E.; Amersey, Rajiv; Bourantas, Christos; Kellman, Peter; Plein, Sven; Moon, James C
• Is Part Of: Journal of magnetic resonance imaging. Volume 50:Issue 3(2019)
• Page Start: 756
• Page End: 762
• Publication Date: 2019-01-25
• Subjects: myocardial perfusion -- perfusion mapping -- coronary artery disease -- inline perfusion quantification -- cardiovascular magnetic resonance; Magnetic resonance imaging -- Periodicals; 616
• DOI: 10.1002/jmri.26668
• Languages: English
• ISSNs: 1053-1807

Abstract

Abstract : Background: Cardiac MR stress perfusion remains a qualitative technique in clinical practice due to technical and postprocessing challenges. However, automated inline perfusion mapping now permits myocardial blood flow (MBF, ml/g/min) quantification on‐the‐fly without user input. Purpose: To investigate the diagnostic performance of this novel technique in detecting occlusive coronary artery disease (CAD) in patients scheduled to undergo coronary angiography. Study Type: Prospective, observational. Subjects: Fifty patients with suspected CAD and 24 healthy volunteers. Field Strength: 1.5T. Sequence: "Dual" sequence multislice 2D saturation recovery. Assessment: All patients underwent cardiac MR with perfusion mapping and invasive coronary angiography; the healthy volunteers had MR with perfusion mapping alone. Statistical Tests: Comparison between numerical variables was performed using an independent t ‐test. Receiver operator characteristic (ROC) curves were generated for transmyocardial, endocardial stress MBF, and myocardial perfusion reserve (MPR, the stress:rest MBF ratio) to diagnose severe (>70%) stenoses as measured by 3D quantitative coronary angiography (QCA). ROC curves were compared by the method of DeLong et al. Results: Compared with volunteers, patients had lower stress MBF and MPR even in vessels with <50% stenosis (2.00 vs. 3.08 ml/g/min, respectively). As stenosis severity increased (<50%, 50–70%, >70%), MBF and MPR decreased. To diagnose occlusive (>70%) CAD, endocardial and transmyocardial stress MBF were superior to MPR (area under the curve 0.92 [95% CI 0.86–0.97] vs. 0.90 [95% CI 0.84–0.95] and 0.80 [95% CI 0.72–0.87], respectively). An endocardial threshold of 1.31 ml/g/min provided a per‐coronary artery sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90%, 82%, 50%, and 98%, with a per‐patient diagnostic performance of 100%, 66%, 57%, and 100%, respectively. Data Conclusion: Perfusion mapping can diagnose occlusive CAD with high accuracy and, in particular, high sensitivity and NPV make it a potential "rule‐out" test. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:756–762.