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Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease¹

¹ From the Departments of Radiology and Cardiology, Beneficencia Portuguesa Hospital, Sao Paulo, Brazil (R.C.C., C.A.M.C., L.A.G.G., D.J.R., J.M.d.G., S.S.L.); Cardiac MRI Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (R.C.C., T.J.B.); and MGH Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.S.). Received July 11, 2005; revision requested August 31; revision received September 29; accepted October 18; final version accepted November 23. Address correspondence to R.C.C. (e-mail: rcury{at}partners.org).

Purpose: To prospectively determine the accuracy of a combined magnetic resonance (MR) imaging approach (stress first-pass perfusion imaging followed by delayed-enhancement imaging) for depicting clinically significant coronary artery stenosis (70% stenosis) in patients suspected of having or known to have coronary artery disease (CAD), with coronary angiography serving as the reference standard.

Materials and Methods: The committee on human research approved the study protocol, and all participants gave written informed consent. This study was HIPAA compliant. Forty-seven patients (38 men and nine women; mean age, 63 years ± 5.3 [standard deviation]) scheduled for coronary angiography were prospectively enrolled: 33 were suspected of having CAD (group A) and 14 had experienced a previous myocardial infarction and were suspected of having new lesions (group B). The MR imaging protocol included cine function, gadolinium-enhanced stress and rest first-pass perfusion MR imaging, and delayed-enhancement MR imaging. Myocardial ischemia was defined as a segment with perfusion deficit at stress first-pass perfusion MR imaging and no hyperenhancement at delayed-enhancement imaging. Myocardial infarction was defined as an area with hyperenhancement at delayed-enhancement imaging.

Results: One patient was excluded from analysis because of poor-quality MR images. Coronary angiography depicted significant stenosis in 30 of 46 patients (65%). In a per-vessel analysis (n = 138), stress first-pass perfusion MR imaging and delayed-enhancement imaging yielded sensitivity of 0.87, specificity of 0.89, and accuracy of 0.88, when compared with coronary angiography. The diagnostic accuracy of stress first-pass perfusion MR imaging and delayed-enhancement imaging was slightly better than that of stress and rest first-pass perfusion MR imaging in the entire population (0.88 vs 0.85), in group A (0.86 vs 0.82), and in group B (0.93 vs 0.90).

Conclusion: Stress first-pass perfusion MR imaging followed by delayed-enhancement imaging is an accurate method to depict significant coronary stenosis in patients suspected of having or known to have CAD.

© RSNA, 2006

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