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DOI: 10.1148/radiol.2401051161
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Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease1

Ricardo C. Cury, MD, Cesar A. M. Cattani, MD, PhD, Luiz A. G. Gabure, MD, Douglas J. Racy, MD, Jose M. de Gois, MD, Uwe Siebert, MD, Sergio S. Lima, MD and Thomas J. Brady, MD

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).


Figure 1
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  		Figure 1: Time-line diagram of MR imaging protocol.

 

Figure 2
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  		Figure 2a: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 

Figure 2
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  		Figure 2b: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 

Figure 2
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  		Figure 2c: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 

Figure 2
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  		Figure 2d: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 

Figure 2
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  		Figure 2e: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 

Figure 2
View larger version (107K):

[in a new window]
  		Figure 2f: Patient with previous myocardial infarction and inducible ischemia. (a, b) Stress first-pass MR images depict hypoperfused area in the anteroseptal wall (black arrow) and in the inferolateral wall (white arrow). (c, d) Delayed-enhancement MR images depict hyperenhancement in the anteroseptal wall in the left anterior descending coronary artery distribution, which represents myocardial infarction (black arrow), but not in the inferolateral wall in the left circumflex artery distribution, which represents inducible ischemia (white arrow). (e) Coronary angiogram depicts occlusion in the left anterior descending artery, which confirms myocardial infarction in the anteroseptal wall (black arrow), and 75% stenosis in the proximal left circumflex artery, which confirms myocardial ischemia in the inferolateral wall (white arrow). (f) Coronary angiogram depicts a right coronary artery without significant stenosis.

 




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