HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2263011902v1 226/3/717    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chiu, C. W. Articles by Sanderson, J. E. Search for Related Content PubMed PubMed Citation Articles by Chiu, C. W. Articles by Sanderson, J. E.

Combined First-Pass Perfusion and Viability Study at MR Imaging in Patients with Non–ST Segment-Elevation Acute Coronary Syndromes: Feasibility Study¹

¹ From the Department of Diagnostic Radiology and Organ Imaging (N.M.C.S., W.W.M.L.) and Department of Medicine and Therapeutics (C.W.C, K.Y.C., J.E.S.), Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Received November 27, 2001; revision requested January 14, 2002; revision received May 14; accepted July 24. Address correspondence to N.M.C.S. (e-mail: so2173@cuhk.edu.hk).

PURPOSE: To assess the feasibility of combined perfusion and viability testing by using magnetic resonance (MR) imaging in one setting in patients with non–ST segment-elevation acute coronary syndromes.

MATERIALS AND METHODS: The data of 13 patients (mean age, 68 years; range, 40–85 years) at high risk for myocardial infarction who underwent MR imaging at 1.5 T were reviewed. Risk factors were increased troponin T levels in seven, reversible ST depression on an electrocardiogram in four, history of myocardial infarction in two, and presence of heart failure in four. Cine imaging of the left ventricle was performed with a true–fast imaging with steady-state precession (FISP) sequence to assess the regional myocardial contraction and ejection fraction. After injection of 0.1 mmol per kilogram of body weight of gadopentetate dimeglumine, first-pass MR images were obtained by using an inversion-recovery true-FISP sequence at rest and during infusion of adenosine (140 µg/kg/min). Resting and stress images were assessed qualitatively for abnormal regional perfusion (hypoenhancement). The myocardium was divided into three radial segments corresponding to the three coronary artery territories. Delayed (after 15 minutes) contrast material–enhanced images were acquired with use of a segmented inversion-recovery fast low-angle shot sequence. Conventional coronary angiograms were compared with the first-pass images. A more than 50% stenosis in diameter in any coronary artery was considered substantial. Mann-Whitney test was used to assess any significant difference between the left ventricular ejection fraction (LVEF) in patients with and those without myocardial infarct.

RESULTS: Mean LVEF was 51.5% (range, 30%–77%). First-pass stress perfusion studies depicted 25 segments of hypoenhancement in 11 patients. Comparison of first-pass perfusion defects with findings on coronary angiograms indicated an overall sensitivity of 92% (24 of 26) and specificity of 92% (12 of 13) in detection of substantial coronary artery disease. Infarcts detected from hyperenhancement on delayed contrast-enhanced images were present in eight segments (four were transmural) in five patients. No significant difference was noted in the LVEF between patients with and those without infarct (P = .724).

CONCLUSION: Combined stress perfusion and viability MR imaging was feasible in patients with acute coronary syndromes. First-pass MR perfusion defects compare well with the presence of substantial coronary artery stenosis on conventional angiograms.

© RSNA, 2003

Index terms: Coronary vessels, stenosis or obstruction, 54.762 • Magnetic resonance (MR), comparative studies, 54.121413, 54.121416, 54.12143, 54.12149 • Magnetic resonance (MR), contrast enhancement, 54.12143

This article has been cited by other articles:

				M Fenchel, A Franow, P Martirosian, M Engels, U Kramer, N I Stauder, U Helber, H Vogler, C D Claussen, and S Miller 1 M Gd-chelate (gadobutrol) for multislice first-pass magnetic resonance myocardial perfusion imaging Br. J. Radiol., November 1, 2007; 80(959): 884 - 892. [Abstract] [Full Text] [PDF]

				N. Merkle, J. Wohrle, O. Grebe, T. Nusser, M. Kunze, H. A Kestler, M. Kochs, and V. Hombach Assessment of myocardial perfusion for detection of coronary artery stenoses by steady-state, free-precession magnetic resonance first-pass imaging Heart, November 1, 2007; 93(11): 1381 - 1385. [Abstract] [Full Text] [PDF]

				K. R. Nandalur, B. A. Dwamena, A. F. Choudhri, M. R. Nandalur, and R. C. Carlos Diagnostic Performance of Stress Cardiac Magnetic Resonance Imaging in the Detection of Coronary Artery Disease: A Meta-Analysis J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1343 - 1353. [Abstract] [Full Text] [PDF]

				J. P. Finn, K. Nael, V. Deshpande, O. Ratib, and G. Laub Cardiac MR Imaging: State of the Technology. Radiology, November 1, 2006; 241(2): 338 - 354. [Abstract] [Full Text] [PDF]

				R. C. Cury, C. A. M. Cattani, L. A. G. Gabure, D. J. Racy, J. M. de Gois, U. Siebert, S. S. Lima, and T. J. Brady Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease. Radiology, July 1, 2006; 240(1): 39 - 45. [Abstract] [Full Text] [PDF]

				A. Huber, S. O. Schoenberg, B. Spannagl, J. Rieber, I. Erhard, V. Klauss, and M. F. Reiser Single-Shot Inversion Recovery TrueFISP for Assessment of Myocardial Infarction. Am. J. Roentgenol., March 1, 2006; 186(3): 627 - 633. [Abstract] [Full Text] [PDF]

				L. F. Rodrigues de Avila, J. L. Fernandes, C. E. Rochitte, G. G. Cerri, and J. P. Filho Perfusion Impairment in Patients with Normal-appearing Coronary Arteries: Identification with Contrast-enhanced MR Imaging Radiology, December 21, 2005; (2005) 2382041697. [Abstract] [Full Text]

				M. Fenchel, A. Franow, N. I. Stauder, U. Kramer, U. Helber, C. D. Claussen, and S. Miller Myocardial Perfusion after Angioplasty in Patients Suspected of Having Single-Vessel Coronary Artery Disease: Improvement Detected at Rest-Stress First-Pass Perfusion MR Imaging--Initial Experience Radiology, October 1, 2005; 237(1): 67 - 74. [Abstract] [Full Text] [PDF]

				M. Fenchel, U. Helber, U. Kramer, N. I. Stauder, A. Franow, C. D. Claussen, and S. Miller Detection of Regional Myocardial Perfusion Deficit Using Rest and Stress Perfusion MRI: A Feasibility Study Am. J. Roentgenol., September 1, 2005; 185(3): 627 - 635. [Abstract] [Full Text] [PDF]

				A. Gupta, V. S. Lee, Y.-C. Chung, J. S. Babb, and O. P. Simonetti Myocardial Infarction: Optimization of Inversion Times at Delayed Contrast-enhanced MR Imaging Radiology, December 1, 2004; 233(3): 921 - 926. [Abstract] [Full Text] [PDF]