Published Online
on August 2, 2004

A more recent version of this article appeared on August 10, 2004

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Submitted on December 29, 2003
Revised on March 10, 2004
Accepted on March 17, 2004

Myocardial First-Pass Perfusion Magnetic Resonance Imaging. A Multicenter Dose-Ranging Study

S. D. Wolff MD, PhD^*, J. Schwitter MD, R. Coulden MD, M. G. Friedrich MD, D. A. Bluemke MD, PhD, R. W. Biederman MD, E. T. Martin MD, A. J. Lansky MD, F. Kashanian MD, T. K.F. Foo PhD, P. E. Licato MS, and C. R. Comeau BS, RT

From the Cardiovascular Research Foundation and Lenox Hill Hospital, New York, NY (S.D.W., A.J.L., C.R.C.); University Hospital of Zurich, Zurich, Switzerland (J.S.); Papworth and Addenbrooke’s Hospitals, Cambridge, UK (R.C.); Franz-Volhard Klinik, Berlin-Buch, Germany (M.G.F.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (D.A.B.); Allegheny General Hospital, Pittsburgh, Pa (R.W.B.); Oklahoma Heart Institute, Tulsa (E.T.M.); Berlex Laboratories, Montville, NJ (F.K.); and GE Medical Systems, Milwaukee, Wis (T.K.F.F., P.E.L.).

^* To whom correspondence should be addressed. E-mail: swolff{at}mrict.com.

Background--MRI can identify patients with obstructive coronary artery disease by imaging the left ventricular myocardium during a first-pass contrast bolus in the presence and absence of pharmacologically induced myocardial hyperemia. The purpose of this multicenter dose-ranging study was to determine the minimally efficacious dose of gadopentetate dimeglumine injection (Magnevist Injection; Berlex Laboratories) for detecting obstructive coronary artery disease.

Method and Results--A total of 99 patients scheduled for coronary artery catheterization as part of their clinical evaluation were enrolled in this study. Patients were randomized to 1 of 3 doses of gadopentate dimeglumine: 0.05, 0.10, or 0.15 mmol/kg. First-pass perfusion imaging was performed during hyperemia (induced by a 4-minute infusion of adenosine at a rate of 140 µg · kg^-1 · min^-1) and then again in the absence of adenosine with otherwise identical imaging parameters and the same contrast dose. Perfusion defects were evaluated subjectively by 4 blinded reviewers. Receiver-operating curve analysis showed that the areas under the receiver-operating curve were 0.90, 0.72, and 0.83 for the low-, medium-, and high-contrast doses, respectively, compared with quantitative coronary angiography (diameter stenosis 70%). For the low-dose group, mean sensitivity was 93±0%, mean specificity was 75±7%, and mean accuracy was 85±3%.

Conclusions--First-pass perfusion MRI is a safe and accurate test for identifying patients with obstructive coronary artery disease. A low dose of 0.05 mmol/kg gadopentetate dimeglumine is at least as efficacious as higher doses.

Key words: adenosine • contrast media • ischemia • magnetic resonance imaging • perfusion

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