Quantitative myocardial perfusion in coronary artery disease: A perfusion mapping study.
Adult
Contrast Media
Coronary Artery Disease
/ diagnostic imaging
Coronary Vessels
/ diagnostic imaging
Female
Gadolinium
Humans
Image Enhancement
/ methods
Image Interpretation, Computer-Assisted
/ methods
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Prospective Studies
Sensitivity and Specificity
cardiovascular magnetic resonance
coronary artery disease
inline perfusion quantification
myocardial perfusion
perfusion mapping
Journal
Journal of magnetic resonance imaging : JMRI
ISSN: 1522-2586
Titre abrégé: J Magn Reson Imaging
Pays: United States
ID NLM: 9105850
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
13
12
2018
revised:
11
01
2019
accepted:
11
01
2019
pubmed:
27
1
2019
medline:
22
10
2020
entrez:
27
1
2019
Statut:
ppublish
Résumé
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. To investigate the diagnostic performance of this novel technique in detecting occlusive coronary artery disease (CAD) in patients scheduled to undergo coronary angiography. Prospective, observational. Fifty patients with suspected CAD and 24 healthy volunteers. 1.5T. SEQUENCE: "Dual" sequence multislice 2D saturation recovery. All patients underwent cardiac MR with perfusion mapping and invasive coronary angiography; the healthy volunteers had MR with perfusion mapping alone. 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. Perfusion mapping can diagnose occlusive CAD with high accuracy and, in particular, high sensitivity and NPV make it a potential "rule-out" test. 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:756-762.
Sections du résumé
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.
Identifiants
pubmed: 30684288
doi: 10.1002/jmri.26668
pmc: PMC6767569
doi:
Substances chimiques
Contrast Media
0
Gadolinium
AU0V1LM3JT
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
756-762Subventions
Organisme : British Heart Foundation
ID : FS/17/34/32901
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/18/83/34025
Pays : United Kingdom
Organisme : British Heart Foundation
ID : RG/16/1/32092
Pays : United Kingdom
Informations de copyright
© 2019 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.
Références
J Cardiovasc Magn Reson. 2017 Oct 9;19(1):75
pubmed: 28992817
J Magn Reson Imaging. 2008 Jun;27(6):1271-7
pubmed: 18421683
J Am Coll Cardiol. 2009 Jul 7;54(2):150-6
pubmed: 19573732
N Engl J Med. 2003 Sep 11;349(11):1027-35
pubmed: 12968086
JACC Cardiovasc Imaging. 2012 Feb;5(2):154-66
pubmed: 22340821
Int J Cardiovasc Imaging. 2012 Aug;28(6):1315-27
pubmed: 22261998
Circ Res. 1989 Oct;65(4):997-1020
pubmed: 2791233
Lancet. 2012 Feb 4;379(9814):453-60
pubmed: 22196944
Radiology. 2004 Sep;232(3):677-84
pubmed: 15284436
J Cardiovasc Magn Reson. 2017 Apr 7;19(1):43
pubmed: 28385161
Circulation. 2000 Mar 28;101(12):1379-83
pubmed: 10736280
J Magn Reson Imaging. 2004 Jul;20(1):39-45
pubmed: 15221807
J Am Coll Cardiol. 2013 May 21;61(20):2098-106
pubmed: 23524053
J Am Coll Cardiol. 2007 Oct 2;50(14):1343-53
pubmed: 17903634
J Am Coll Cardiol. 2013 Aug 27;62(9):826-38
pubmed: 23727209
J Am Coll Cardiol. 2013 Oct 29;62(18):1639-1653
pubmed: 23954338
J Cardiovasc Magn Reson. 2013 Oct 08;15:91
pubmed: 24103764
J Am Coll Cardiol. 2003 Apr 16;41(8):1387-93
pubmed: 12706936
Int J Cardiol. 2013 Sep 30;168(2):934-45
pubmed: 23218570
J Nucl Cardiol. 2004 Jul-Aug;11(4):440-9
pubmed: 15295413
Magn Reson Med. 2013 Jun;69(6):1768-76
pubmed: 22791598
J Am Coll Cardiol. 2010 Aug 10;56(7):561-9
pubmed: 20688211
Circulation. 2007 May 8;115(18):2418-25
pubmed: 17452610
Eur Heart J. 2013 Mar;34(10):775-81
pubmed: 22390914
J Am Coll Cardiol. 2011 Jan 4;57(1):70-5
pubmed: 21185504
N Engl J Med. 2010 Mar 11;362(10):886-95
pubmed: 20220183
J Cardiovasc Magn Reson. 2010 May 19;12:29
pubmed: 20482819
Circulation. 2002 Jan 29;105(4):539-42
pubmed: 11815441
Biometrics. 1988 Sep;44(3):837-45
pubmed: 3203132
Magn Reson Med. 2018 Dec;80(6):2641-2654
pubmed: 29672922
J Cardiovasc Magn Reson. 2017 Oct 19;19(1):78
pubmed: 29047385