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Hypertrophic Cardiomyopathy: MR Measurement of Coronary Blood Flow and Vasodilator Flow Reserve in Patients and Healthy Subjects¹

¹ From the Departments of Radiology (N.K., H.S., K.T.) and Internal Medicine (T.Y., N.I., T.N.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; and the Department of Radiology, University of California, San Francisco (C.B.H.). From the 1997 RSNA scientific assembly. Received May 11, 1998; revision requested July 10; revision received September 9; accepted October 27. Address reprint requests to N.K.

View larger version (127K): [in a new window]   Figure 1. Axial scout MR image acquired from a 49-year-old healthy female volunteer, with a breath-hold cine MR sequence (9/2; section thickness, 5 mm; field of view, 28 x 28 cm; 128 phase-encoding steps; eight views per segment). The oblique coronal imaging plane (long white line) is perpendicular to the coronary sinus (short white line).

View larger version (120K): [in a new window]   Figure 2a. Breath-hold VEC MR images obtained in the oblique coronal imaging plane from a 56-year-old man with HCM. a, Magnitude image and b, phase difference image (15/5). The blood flow velocity in the coronary sinus (arrow) is indicated as low signal intensity in b.

View larger version (132K): [in a new window]   Figure 2b. Breath-hold VEC MR images obtained in the oblique coronal imaging plane from a 56-year-old man with HCM. a, Magnitude image and b, phase difference image (15/5). The blood flow velocity in the coronary sinus (arrow) is indicated as low signal intensity in b.

View larger version (17K): [in a new window]   Figure 3. Curve of volume flow in the coronary sinus measured with breath-hold VEC MR imaging in a 56-year-old man with HCM. Biphasic blood flow pattern, with a first peak during systole and a second peak during diastole, was observed.

View larger version (141K): [in a new window]   Figure 4a. Short-axis MR images of the left ventricle obtained with a breath-hold cine MR sequence (10/2) in a 24-year-old healthy female volunteer. (a) End-diastolic image. (b) End-systolic image. A normal left ventricular wall (arrow) is demonstrated, with good contrast between the blood pool and the myocardium.

View larger version (139K): [in a new window]   Figure 4b. Short-axis MR images of the left ventricle obtained with a breath-hold cine MR sequence (10/2) in a 24-year-old healthy female volunteer. (a) End-diastolic image. (b) End-systolic image. A normal left ventricular wall (arrow) is demonstrated, with good contrast between the blood pool and the myocardium.

View larger version (126K): [in a new window]   Figure 5a. Short-axis MR images of the left ventricle obtained with a breath-hold cine MR sequence (10/2) in a 62-year-old man with HCM. (a) End-diastolic and (b) end-systolic images demonstrate that the left ventricular wall (arrow) is hypertrophic.

View larger version (122K): [in a new window]   Figure 5b. Short-axis MR images of the left ventricle obtained with a breath-hold cine MR sequence (10/2) in a 62-year-old man with HCM. (a) End-diastolic and (b) end-systolic images demonstrate that the left ventricular wall (arrow) is hypertrophic.

View larger version (16K): [in a new window]   Figure 6a. Graphs of the coronary blood flow per gram of myocardial mass (a) in the baseline state and (b) after dipyridamole injection. The mean coronary blood flow per gram of myocardial mass in patients with HCM was significantly lower than that in healthy subjects after dipyridamole administration. LV = left ventricle, NS = not significant.

View larger version (16K): [in a new window]   Figure 6b. Graphs of the coronary blood flow per gram of myocardial mass (a) in the baseline state and (b) after dipyridamole injection. The mean coronary blood flow per gram of myocardial mass in patients with HCM was significantly lower than that in healthy subjects after dipyridamole administration. LV = left ventricle, NS = not significant.

View larger version (23K): [in a new window]   Figure 7a. Graphs of the coronary blood flow per gram of myocardial mass before and after dipyridamole injection. The increase in coronary blood flow was more substantial in (a) healthy subjects than in (b) patients with HCM. LV = left ventricle.

View larger version (30K): [in a new window]   Figure 7b. Graphs of the coronary blood flow per gram of myocardial mass before and after dipyridamole injection. The increase in coronary blood flow was more substantial in (a) healthy subjects than in (b) patients with HCM. LV = left ventricle.

View larger version (14K): [in a new window]   Figure 8. Graph of the coronary flow reserve (CFR) ratios in healthy subjects and in patients with HCM. The mean coronary flow reserve ratio was significantly lower in patients with HCM than in healthy subjects.

View larger version (12K): [in a new window]   Figure 9. Graph of the correlation between the coronary flow reserve (CFR) ratio and the left ventricular (LV) mass index in all subjects. A significant negative correlation was found between the coronary flow reserve ratio and the left ventricular mass index (r = -0.60; P < .01). BSA = body surface area, = healthy subject, • = patient with HCM.