(Circulation. 2001;103:2230.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessment of Myocardial Perfusion in Coronary Artery Disease by Magnetic Resonance
A Comparison With Positron Emission Tomography and Coronary Angiography
From the Division of Cardiology (J.S., M.B., T.F.L.), the Clinic of Nuclear Medicine (S.K., G.K.v.S.), and the Institute of Diagnostic Radiology (D.N., K.B., P.R.K., B.M.), University Hospital Zurich, Zurich, Switzerland.
Correspondence to J. Schwitter, MD, Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail karscz{at}usz.unizh.ch
Background—Monitoring contrast medium wash-in kinetics in hyperemic myocardium by magnetic resonance (MR) allows for the detection of stenosed coronary arteries. In this prospective study, the quality of a multislice MR approach with respect to the detection and sizing of compromised myocardium was determined and compared with positron emission tomography (PET) and quantitative coronary angiography.
Methods and Results—A
total of 48 patients and 18 healthy subjects were studied by MR
using a multislice hybrid echo-planar pulse sequence for monitoring the
myocardial first pass kinetics of gadolinium-diethylenetriamine
pentaacetic acid bismethylamide
(Omniscan; 0.1 mmol/kg injected at 3 mL/s
IV) during hyperemia (dipyridamole 0.56 mg/kg).
Signal intensity upslope as a measure of myocardial perfusion
was calculated in 32 sectors per heart from pixelwise
parametric maps in the subendocardial layer and for full wall
thickness. Before coronary angiography, coronary flow
reserve (hyperemia induced by dipyridamole 0.56
mg/kg) was determined in corresponding sectors by
13N-ammonia PET. Receiver-operator
characteristic analysis of subendocardial upslope data revealed
a sensitivity and specificity of 91% and 94%, respectively, for the
detection of coronary artery disease as defined by PET (mean
coronary flow reserve minus 2SD of controls) and a sensitivity
and specificity of 87% and 85%, respectively, in comparison with
quantitative coronary angiography (diameter stenosis
50%). The number of pathological sectors per patient on PET and MR
studies correlated linearly (slope, 0.94;
r=0.76;
P<0.0001).
Conclusions—The presented MR approach reliably identifies patients with coronary artery stenoses and provides information on the amount of compromised myocardium, even when perfusion abnormalities are confined to the subendocardial layer. This modality may qualify for its clinical application in the management of coronary artery disease.
Key Words: imaging • perfusion • heart diseases
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