Noninvasive stress testing of myocardial ischemia: comparison of GRE-MRI perfusion and wall motion analysis to 99 mTc-MIBI-SPECT, relation to coronary angiography

Bremerich, Jens; Buser, Peter; Bongartz, G.; Müller-Brand, Jan; Grädel, Christoph; Pfisterer, Matthias; Steinbrich, W.

doi:10.1007/s003300050238

Cited by 22 publications

(11 citation statements)

References 26 publications

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“…Previous reports revealed that MRI perfusion images are as good as conventional nuclear perfusion images. [36][37][38][39] As a result, we speculate that our results are also closely correlated with conventional nuclear perfusion imagings. Lastly, we did not evaluate the effect of coronary revascularization on MRI perfusion images.…”

Section: Discussionsupporting

confidence: 61%

Whole-Heart Dipyridamole Stress First-Pass Myocardial Perfusion MRI for the Detection of Coronary Artery Disease

et al. 2004

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SUMMARYA whole-heart coverage MRI sequence, which employes a hybrid of fast gradient echo and echo planar acquisition imaging (FastCard EchoTrain), has recently been developed. Using this sequence, a first-pass myocardial perfusion MRI was shown to be a good noninvasive modality for detecting coronary artery disease (CAD) in a clinical setting. In addition, the clinical usefulness of delayed enhanced MRI has recently been reported. The objectives of this study were (1) to investigate the accuracy of dipyridamole stress firstpass myocardial perfusion MRI for diagnosing CAD (> 50% stenosis) and (2) to clarify whether additional delayed enhancement MRI has any clinical significance. We performed first-pass myocardial perfusion MRI in 102 consecutive patients (66 ± 9 years old) suspected to have CAD or new lesions in patients with well-documented prior myocardial infarction (MI). Using a 1.5 T cardiac MR imager (GE CV/i), eight short axis MR images of the left ventricle were acquired by injecting gadolinium (0.1 mmol/kg) under dipyridamole infusion stress (0.56 mg/kg). Fifteen minutes later, aminophylline (250 mg) was injected and first-pass perfusion MRI was repeated in the resting state in order to evaluate both the presence of perfusion defect and delayed enhancement. The presence of perfusion defect and delayed enhancement was determined based on a visual qualitative analysis by the agreement of two separate readers who were blinded to any clinical information. Based on the stress and rest findings, no defect, reversible defect, or fixed defect with or without delayed enhancement was recorded in any patient. The MR findings revealed 76 CAD patients, including 24 MI patients with new lesions and 26 patients without CAD on coronary angiography. The presence of stress perfusion defect had a 93% sensitivity and an 85% specificity for diagnosing CAD. A fixed defect showed an 86% sensitivity and a 66% specificity for diagnosing a prior MI. Patients with a fixed defect with delayed enhancement had more significant stenosis in the infarct related artery than in those without any enhancement (11/26 vs 15/20, P < 0.05).

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Section: Discussionsupporting

confidence: 61%

Whole-Heart Dipyridamole Stress First-Pass Myocardial Perfusion MRI for the Detection of Coronary Artery Disease

et al. 2004

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“…Wall-motion and wall thickening abnormalities reveals regional myocardial dysfunction (3,4). In our study, 75% of the severely stenotic or occluded vessels territories segments demonstrate wall motion abnormality.…”

Section: Sensky Et Almentioning

confidence: 81%

“…Myocardial oxygen need directly associates with perfusion thus in the evaluation of ischemia, perfusion is more sensitive than wall motion (4,5). In severe coronary arteries' stenosis collateral development can be insufficient resulting in functional impairment of the myocardial metabolism on the poststenotic region (6).…”

Section: Discussionmentioning

confidence: 99%

“…This area responds to inotropic agents (reverse tethering). Therefore might be misinterpreted as ischemia (4).…”

Section: Sensky Et Almentioning

confidence: 99%

“…Other advantages include three-dimensional imaging and lack of irradiation (1)(2)(3)(4). The aim of this study is to evaluate the left ventricular wall motion abnormalities, perfusion, and late contrast enhancement patterns on MRI in patients with 70% or higher degree stenosis or occlusion of coronary arteries on coronary angiography.…”

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confidence: 99%

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