Noninvasive Detection of Myocardial Ischemia From Perfusion Reserve Based on Cardiovascular Magnetic Resonance

Al-Saadi, Nidal; Nagel, Eike; Groß, Michael; Bornstedt, Axel; Schnackenburg, Bernhard; Klein, Christoph; Klimek, Waldemar J.; Oswald, H. R.; Fleck, Eckart

doi:10.1161/01.cir.101.12.1379

Cited by 527 publications

(359 citation statements)

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“…In a small study of 48 patients and 18 healthy subjects, a coronary flow reserve less than 1.65 had a sensitivity and specificity of 91% and 94%, respectively, for the detection of CAD as defined by PET scanning. 49 There is growing evidence on the prognostic ability of CMR in symptomatic women at risk for CAD. In one of the first reports assessing the prognostic value of CMR with adenosine and dobutamine, 513 patients were evaluated for CAD, with a mean follow-up of 2.3 years.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Vavas¹,

Hong²,

Rosen³

et al. 2012

Clinical Cardiology

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Significant advances in medical treatment, medical technology, and the focus on sex-specific research have contributed to a reduction in cardiovascular mortality in women. Despite these advances, coronary artery disease (CAD) is the leading cause of cardiovascular death of women in the Western world. In the past 2 decades, the focused research on women at risk for CAD has helped to clarify our understanding of some of the sex-specific factors that are important in the detection of CAD. In women, the detection and evaluation of physiologically significant CAD can be challenging. Many of the traditional tests that are designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients, who have a greater burden of symptoms, higher atherosclerotic burden, and lower prevalence of obstructive coronary disease. In this article, we review the available evidence on the role of contemporary noninvasive diagnostic techniques in the evaluation of women with symptoms of CAD.

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Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Vavas¹,

Hong²,

Rosen³

et al. 2012

Clinical Cardiology

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“…Cardiovascular magnetic resonance (CMR) is increasingly applied in clinical routine to determine myocardial perfusion [1-4] using contrast enhanced first-pass perfusion techniques [5-8]. Non-invasive characterization of myocardial microcirculation is thought to reflect myocardial tissue supply much better than mere luminographic detection and quantification of epicardial coronary stenosis, and has been shown to be useful for planning of revascularization procedures and cardiac risk stratification.…”

Section: Introductionmentioning

confidence: 99%

BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia

Manka¹,

Paetsch

Schnackenburg

et al. 2010

Journal of Cardiovascular Magnetic Resonance

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BackgroundThe purpose of this study was to determine the ability of Blood Oxygen Level Dependent (BOLD) cardiovascular magnetic resonance (CMR) to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD).MethodsForty-six patients (34 men; age 65 ± 9 years,) with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was performed in 3 short axis slices of the heart at rest and during adenosine stress (140 μg/kg/min) followed by late gadolinium enhancement (LGE) imaging. In all 16 standard myocardial segments, T2* values were derived at rest and under adenosine stress. Quantitative coronary angiography served as the standard of reference and defined normal myocardial segments (i.e. all 16 segments in patients without any CAD), ischemic segments (i.e. supplied by a coronary artery with ≥50% luminal narrowing) and non-ischemic segments (i.e. supplied by a non-significantly stenosed coronary artery in patients with significant CAD).ResultsCoronary angiography demonstrated significant CAD in 23 patients. BOLD CMR at rest revealed significantly lower T2* values for ischemic segments (26.7 ± 11.6 ms) compared to normal (31.9 ± 11.9 ms; p < 0.0001) and non-ischemic segments (31.2 ± 12.2 ms; p = 0.0003). Under adenosine stress T2* values increased significantly in normal segments only (37.2 ± 14.7 ms; p < 0.0001).ConclusionsRest and stress BOLD CMR at 3Tesla proved feasible and differentiated between ischemic, non-ischemic, and normal myocardial segments in a clinical patient population. BOLD CMR during vasodilator stress identified patients with significant CAD.

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“…The standard solution of Eqs. [1] and [2] is obtained by convolving the input function C input with a decaying exponential. Each preprocessed image has on the order of 10,000 pixels, and each pixel has a time curve of approximately 70 points.…”

Section: Model-based Methodsmentioning

confidence: 99%

“…DYNAMIC MR EVALUATION of myocardial perfusion is becoming a powerful tool for the detection of coronary artery disease (1)(2)(3). The standard approach is to rapidly acquire T1-weighted images to track the uptake and washout of the contrast agent Gd-DTPA.…”

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confidence: 99%

Model‐based registration for dynamic cardiac perfusion MRI

Adluru

DiBella

Schabel

2006

Magnetic Resonance Imaging

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Purpose:To assess the accuracy of a model-based approach for registration of myocardial dynamic contrastenhanced (DCE)-MRI corrupted by respiratory motion. Materials and Methods:Ten patients were scanned for myocardial perfusion on 3T or 1.5T scanners, and short-and long-axis slices were acquired. Interframe registration was done using an iterative model-based method in conjunction with a mean square difference metric. The method was tested by comparing the absolute motion before and after registration, as determined from manually registered images. Regional flow indices of myocardium calculated from the manually registered data were compared with those obtained with the model-based registration technique. Results:The mean absolute motion of the heart for the short-axis data sets over all the time frames decreased from 5.3 Ϯ 5.2 mm (3.3 Ϯ 3.1 pixels) to 0.8 Ϯ 1.3 mm (0.5 Ϯ 0.7 pixels) in the vertical direction, and from 3.0 Ϯ 3.7 mm (1.7 Ϯ 2.1 pixels) to 0.9 Ϯ 1.2 mm (0.5 Ϯ 0.7 pixels) in the horizontal direction. A mean absolute improvement of 77% over all the data sets was observed in the estimation of the regional perfusion flow indices of the tissue as compared to those obtained from manual registration. Similar results were obtained with two-chamber-view long-axis data sets. Conclusion:The model-based registration method for DCE cardiac data is comparable to manual registration and offers a unique registration method that reduces errors in the quantification of myocardial perfusion parameters as compared to those obtained from manual registration. DYNAMIC MR EVALUATION of myocardial perfusion is becoming a powerful tool for the detection of coronary artery disease (1-3). The standard approach is to rapidly acquire T1-weighted images to track the uptake and washout of the contrast agent Gd-DTPA. Multiple 2D images are acquired each heartbeat. The slices are acquired using ECG-gated sequences so that a given slice is always acquired during the same phase of the cardiac cycle. The time-series data are analyzed visually or with semiquantitative or quantitative models (4,5). Depending on the analysis technique used, at least 20 -40 seconds of data are needed to determine regional perfusion values in the left ventricular (LV) myocardium. Many patients cannot hold their breath long enough to provide a motion-free study. A breathhold of any appreciable length becomes more difficult when pharmacological stress is induced by vasodilating agents, which is necessary for detection of coronary artery disease. Respiration causes motion of the heart, which makes qualitative visual analysis difficult and can cause incorrect estimation of semiquantitative and quantitative parameters.A number of registration methods have been proposed to correct the motion of the heart in dynamic contrast MRI acquisitions (6 -10). In the method of Bidaut and Vallee (6), the mean squared difference between images in the perfusion sequence and a reference image in a region defined by a cardiac mask is minimized. The initial reference image is c...

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Noninvasive Detection of Myocardial Ischemia From Perfusion Reserve Based on Cardiovascular Magnetic Resonance

Cited by 527 publications

References 32 publications

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Noninvasive Diagnostic Techniques for Coronary Disease in Women

BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia

Model‐based registration for dynamic cardiac perfusion MRI

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