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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 Experience¹

¹ From the Departments of Diagnostic Radiology (M.F., N.I.S., U.K., C.D.C., S.M.) and Internal Medicine, Division of Cardiology (A.F., U.H.), Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str 3, 72076 Tuebingen, Germany. Received June 9, 2004; revision requested August 20; revision received October 20; accepted December 10. Address correspondence to M.F. (e-mail: michael.fenchel{at}med.uni-tuebingen.de).

View larger version (105K): [in a new window]   Figure 1a. Images from a 70-year-old patient with 95% stenosis in the left anterior descending artery. (a, b) Short-axis perfusion MR series acquired with a two-dimensional saturation-recovery SSFP sequence (2.4/1.2; field of view, 225 x 300 mm; matrix, 72 x 128; flip angle, 55°) (a) before intervention and (b) after stent placement. A perfusion deficit (arrow) was observed in the anterior-septal wall of the left ventricle only on a. Note the slightly different section positions on both sets of images. (c, d) Right anterior oblique conventional angiograms display the left anterior descending artery with high-grade stenosis (arrow) (c) before intervention and (d) after stent placement. (e) A short-axis view from the SPECT stress examination prior to intervention shows a corresponding anteroseptal perfusion deficit.

View larger version (83K): [in a new window]   Figure 1b. Images from a 70-year-old patient with 95% stenosis in the left anterior descending artery. (a, b) Short-axis perfusion MR series acquired with a two-dimensional saturation-recovery SSFP sequence (2.4/1.2; field of view, 225 x 300 mm; matrix, 72 x 128; flip angle, 55°) (a) before intervention and (b) after stent placement. A perfusion deficit (arrow) was observed in the anterior-septal wall of the left ventricle only on a. Note the slightly different section positions on both sets of images. (c, d) Right anterior oblique conventional angiograms display the left anterior descending artery with high-grade stenosis (arrow) (c) before intervention and (d) after stent placement. (e) A short-axis view from the SPECT stress examination prior to intervention shows a corresponding anteroseptal perfusion deficit.

View larger version (120K): [in a new window]   Figure 1c. Images from a 70-year-old patient with 95% stenosis in the left anterior descending artery. (a, b) Short-axis perfusion MR series acquired with a two-dimensional saturation-recovery SSFP sequence (2.4/1.2; field of view, 225 x 300 mm; matrix, 72 x 128; flip angle, 55°) (a) before intervention and (b) after stent placement. A perfusion deficit (arrow) was observed in the anterior-septal wall of the left ventricle only on a. Note the slightly different section positions on both sets of images. (c, d) Right anterior oblique conventional angiograms display the left anterior descending artery with high-grade stenosis (arrow) (c) before intervention and (d) after stent placement. (e) A short-axis view from the SPECT stress examination prior to intervention shows a corresponding anteroseptal perfusion deficit.

View larger version (157K): [in a new window]   Figure 1d. Images from a 70-year-old patient with 95% stenosis in the left anterior descending artery. (a, b) Short-axis perfusion MR series acquired with a two-dimensional saturation-recovery SSFP sequence (2.4/1.2; field of view, 225 x 300 mm; matrix, 72 x 128; flip angle, 55°) (a) before intervention and (b) after stent placement. A perfusion deficit (arrow) was observed in the anterior-septal wall of the left ventricle only on a. Note the slightly different section positions on both sets of images. (c, d) Right anterior oblique conventional angiograms display the left anterior descending artery with high-grade stenosis (arrow) (c) before intervention and (d) after stent placement. (e) A short-axis view from the SPECT stress examination prior to intervention shows a corresponding anteroseptal perfusion deficit.

View larger version (75K): [in a new window]   Figure 1e. Images from a 70-year-old patient with 95% stenosis in the left anterior descending artery. (a, b) Short-axis perfusion MR series acquired with a two-dimensional saturation-recovery SSFP sequence (2.4/1.2; field of view, 225 x 300 mm; matrix, 72 x 128; flip angle, 55°) (a) before intervention and (b) after stent placement. A perfusion deficit (arrow) was observed in the anterior-septal wall of the left ventricle only on a. Note the slightly different section positions on both sets of images. (c, d) Right anterior oblique conventional angiograms display the left anterior descending artery with high-grade stenosis (arrow) (c) before intervention and (d) after stent placement. (e) A short-axis view from the SPECT stress examination prior to intervention shows a corresponding anteroseptal perfusion deficit.

View larger version (42K): [in a new window]   Figure 2. Graph of MPRI for remote segments, as well as for segments from hypoperfused regions. After intervention, a significant increase in MPRI is observed (P < .001). At follow-up examination, myocardial perfusion normalizes in most patients. Right error bar represents mean and standard deviation of patients without thoracic discomfort at follow-up MR examinations.

View larger version (36K): [in a new window]   Figure 3. Graph of MPRI in patients in the PTCA only group (left) and the stent group (right). Both groups show a significant increase in MPRI after intervention. However, patients in the PTCA only group had an increase from 1.08 ± 0.27 to 1.87 ± 0.39 (72% increase), whereas patients in the stent group had an increase from 1.04 ± 0.24 to 2.18 ± 0.57 (156% increase) after intervention (P < .001). Right error bars (*) represent mean and standard deviation of patients without thoracic discomfort at follow-up MR examinations.