Magnetic resonance first-pass myocardial perfusion imaging: Clinical validation and future applications

Wilke, Norbert; Jerosch‐Herold, Michael; Zenovich, Andrey G.; Stillman, Arthur E.

doi:10.1002/(sici)1522-2586(199911)10:5<676::aid-jmri10>3.0.co;2-l

Cited by 135 publications

(69 citation statements)

References 32 publications

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“…[23][24][25] Although quantitative determinations of flow reserve are of great value in studying pathophysiology, they require left ventricular blood pool as well as myocardial imaging, 2 sets rather than 1 of first-pass images, and relatively complex modeling. 19 The interpretation of an individual value of flow reserve can also be problematic. Although absolute values of flow reserve are reduced locally beyond stenotic lesions, they are also reduced diffusely by processes seen commonly in coronary patients, eg, hypertrophy and small-vessel disease.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in studies performed during pharmacological coronary vasodilation, the perfusion deficits identified have no doubt included areas of myocardial infarction as well as viable myocardium having limited coronary flow reserve. Wilke et al 19 summarized studies through 1999. Of 21 studies (which included a total of more than 500 patients), 85% used coronary vasodilation with adenosine or dipyridamole.…”

Section: Discussionmentioning

confidence: 99%

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Limits of Detection of Regional Differences in Vasodilated Flow in Viable Myocardium by First-Pass Magnetic Resonance Perfusion Imaging

et al. 2001

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Background-Perfusion imaging techniques intended to identify regional limitations in coronary flow reserve in viable myocardium need to identify 2-fold differences in regional flow during coronary vasodilation consistently. This study evaluated the suitability of current first-pass magnetic resonance approaches for evaluating such differences, which are 1 to 2 orders of magnitude less than in myocardial infarction. Methods and Results-Graded regional differences in vasodilated flow were produced in chronically instrumented dogs with either left circumflex (LCx) infusion of adenosine or partial LCx occlusion during global coronary vasodilation. First-pass myocardial signal intensity-time curves were obtained after right atrial injection of gadoteridol (0.025 mmol/ kg) with an MRI inversion recovery true-FISP sequence. The area under the initial portion of the LCx curve was compared with that of a curve from a remote area of the ventricle. Relative LCx and remote flows were assessed simultaneously with microspheres. The ratio of LCx and remote MRI curve areas and the ratio of LCx and remote microsphere concentrations were highly correlated and linearly related over a 5-fold range of flow differences (yϭ0.96xϮ0.07, PϽ0.0001, r 2 ϭ0.87). The 95% confidence limits for individual MRI measurements were Ϯ35%. Regional differences of Ն2-fold were consistently apparent in unprocessed MR images. Conclusions-Clinically relevant regional reductions in vasodilated flow in viable myocardium can be detected with 95%confidence over the range of 1 to 5 times resting flow. This suggests that MRI can identify and quantify limitations in perfusion reserve that are expected to be produced by stenoses of Ն70%. Key Words: magnetic resonance imaging Ⅲ regional blood flow Ⅲ vasodilation F irst-pass contrast-based MR perfusion imaging of the myocardium has received increasing attention as approaches providing improved temporal and spatial resolution and signal-to-noise ratio have become available. Clinical studies have focused on the identification of regional perfusion deficits indicating the presence of coronary artery disease. Because most studies have been performed during pharmacological coronary vasodilation, the perfusion deficits have included areas of both myocardial infarction and viable myocardium having limited coronary flow reserve.The identification of a regional limitation in flow reserve in viable myocardium is based on the identification of a relative reduction in perfusion during coronary vasodilation. Pharmacological vasodilation can increase resting flow 4-to 8-fold in normally perfused viable tissue, whereas a lesser increase occurs in areas supplied by stenotic arteries. 1,2 Because 70% diameter stenoses reduce vasodilated flow by only Ϸ50%, 2-5 a clinically useful technique needs to identify 2-fold regional differences in vasodilated flow consistently. This is an appreciably more demanding requirement than when perfusion imaging is used to identify areas of myocardial infarction, ie, resting blood flow in infarcted ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Limits of Detection of Regional Differences in Vasodilated Flow in Viable Myocardium by First-Pass Magnetic Resonance Perfusion Imaging

et al. 2001

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“…With these infusion protocols, the total dose used to obtain all imaging data in each study was 0.2 to 0.25 mmol/kg Gd-DTPA. In comparison, with peripheral delivery, a single three-dimensional GRE breath-hold coronary MR angiogram requires 0.2 mmol/kg of Gd-based MR contrast agent (29), and each first pass study requires an additional 0.05 mmol/kg (30).…”

Section: Resultsmentioning

confidence: 99%

Dynamic coronary MR angiography and first‐pass perfusion with intracoronary administration of contrast agent

Tsekos

Woodard

Foster

et al. 2002

Magnetic Resonance Imaging

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Purpose: To evaluate whether dynamic imaging of the coronary arteries can be performed with intracoronary infusion of low-dose gadolinium (Gd)-based contrast agent and assess the effect of long duration and multiple infusions on the image signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Materials and Methods:Dynamic coronary magnetic resonance (MR) imaging (130 msec/image) and contrast agent first pass myocardial perfusion studies were performed with intracoronary infusions of low-dose Gd-based MR contrast agent on dogs (N ϭ 4) using a fast multislice gradient recalled echo (GRE) sequence.Results: Contrast-enhanced coronary arteries were clearly imaged during infusion periods as long as 2.3 minutes. The SNR and CNR of the contrast-enhanced coronary arteries remained essentially unchanged over multiple consecutive angiographic sessions. In addition, we demonstrated that first pass studies performed with intracoronary injection of MR contrast agent can be used as a means of assessing regional myocardial perfusion. Conclusion:These studies demonstrated that, using intracoronary infusion of Gd, coronary magnetic resonance angiography (MRA) can be performed with high temporal resolution, and multiple low-dose slow infusions of Gd-based MR contrast agent can be performed without compromise of the vessel SNR and CNR. VASCULAR INTERVENTIONS require high spatial resolution and fast angiographic imaging. Currently, contrast-enhanced x-ray angiography, with its real-time temporal resolution and sub-millimeter spatial resolution, is the method of choice for monitoring and performing vascular procedures. Several recent studies (1-5) suggest the potential of magnetic resonance (MR) imaging to guide vascular interventions. Compared to x-ray angiography, MR offers several benefits. First, because of its high contrast resolution and intrinsic sensitivity to flow, MR allows the assessment of both morphology and function. Second, unlike x-ray angiography, MR imaging is intrinsically three-dimensional, allowing free selection of volume and scan-planes. These can be selected to better visualize the procedure without manually repositioning the patient or imaging instrument. Third, MR imaging does not use ionizing radiation, and therefore is safer for both the medical staff and patient. In addition, MR gadolinium (Gd)-based contrast agents are less toxic and have fewer side effects than iodinated x-ray contrast agents (6,7).In principle, MR imaging can provide an integrated and comprehensive approach to vascular intervention, permitting diagnosis of a vascular pathological condition, guidance of a suitable intervention, and assessment of the interventional results during the same session and with the same modality. Recent studies have demonstrated MR visualization of vascular catheters and interventional devices with passive (8 -11) and active methods (2,(12)(13)(14), and contrast-enhanced angiography with submillimeter spatial resolution (15). In addition, MR guidance has been used in performing percutaneous translumina...

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“…The precise morphology of the heart and the great vessels can be assessed without exposing the patient to radiation. In addition, functional CMR studies that mainly measure the myocardial perfusion and flow offer new non-invasive diagnostic possibilities in patients with suspected or known coronary artery disease (7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

et al. 2011

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Objective: We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. Materials and Methods: One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. Results: In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 ± 11.7 versus 82.4 ± 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 ± 1.9% versus 97 ± 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 ± 24.0 versus 140.9 ± 25.7 mmHg; diastolic: 80.2 ± 12.5 mmHg versus 78.9 ± 15.6, respectively). Conclusion: This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.

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Magnetic resonance first-pass myocardial perfusion imaging: Clinical validation and future applications

Cited by 135 publications

References 32 publications

Limits of Detection of Regional Differences in Vasodilated Flow in Viable Myocardium by First-Pass Magnetic Resonance Perfusion Imaging

Limits of Detection of Regional Differences in Vasodilated Flow in Viable Myocardium by First-Pass Magnetic Resonance Perfusion Imaging

Dynamic coronary MR angiography and first‐pass perfusion with intracoronary administration of contrast agent

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

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