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Contrast-enhanced Cardiac MR Imaging in the Detection of Reduced Coronary Flow Velocity Reserve¹

¹ From the Clinic of Cardiology/Angiology, Heart Center (A.A.B., C.T., A.K.S., K.M., T.A.H., T.H., T.M., G.K.L.), and Clinic of Diagnostic and Interventional Radiology (A.S., G.A.), University Hospital Hamburg-Eppendorf, Martini-strasse 52, 20246 Hamburg, Germany. Received February 20, 2006; revision requested April 24; revision received May 31; accepted June 21; final version accepted September 1. Supported in part by Bracco-Altana Pharma, Konstanz, Germany. Address correspondence to A.A.B. (e-mail: barmeyer{at}uke.uni-hamburg.de).

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Diagrams show segments assigned to vascular regions. On every section, segments 6, 1, and 2 were assigned to the left anterior descending artery (LAD); segments 2, 3, and 4, to the circumflex artery (CFX); and segments 4 and 5, to the right coronary artery (RCA).

View larger version (108K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Example of perfusion measurement in a patient with a CFR of 1.7 in the right coronary artery. (a) Sequential cardiac MR images (2.2/1.1, 50° flip angle°) obtained with a short-axis view in the center section show the first pass of a bolus of contrast material during rest (top row) and stress (bottom row). A region of delayed contrast material inflow is identified by a dark area in the inferior and inferoseptal segments (arrowheads). (b) Signal intensity–time curves obtained in segment 5 at rest and stress show that the delayed contrast material inflow results in a reduced upslope during stress compared with rest. AU = arbitrary units, SI = signal intensity.

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Example of perfusion measurement in a patient with a CFR of 1.7 in the right coronary artery. (a) Sequential cardiac MR images (2.2/1.1, 50° flip angle°) obtained with a short-axis view in the center section show the first pass of a bolus of contrast material during rest (top row) and stress (bottom row). A region of delayed contrast material inflow is identified by a dark area in the inferior and inferoseptal segments (arrowheads). (b) Signal intensity–time curves obtained in segment 5 at rest and stress show that the delayed contrast material inflow results in a reduced upslope during stress compared with rest. AU = arbitrary units, SI = signal intensity.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 3: Flow diagram of the patients eligible for participation in the study. Five patients were not included in the final evaluation for various reasons. ce-CMR = contrast-enhanced cardiac MR imaging.

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Bland-Altman plot of MPRI measurements in the subendocardium, with good interobserver agreement between observers 1 and 2 and a mean difference of 0.01 ± 0.27.

View larger version (5K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Graph shows the linear correlation between the CFR and MPRI in the three lowest segments of a vascular region with subendocardial analysis (MPRIsub3), which is calculated with 0.943 + (0.128 · CFR) (r = 0.44, P < .05).

View larger version (10K): [in this window] [in a new window] [Download PPT slide]   Figure 6: Box plots (indicating minimum, 25% quartile, median, 75% quartile, and maximum values) of transmural (left plot) and subendocardial (right plot) perfusion measurements in vascular regions with a normal CFR of at least 2.00 and a reduced CFR of less than 2.00. The mean MPRI for the segments with the three lowest transmural MPRI values (MPRItrans3) and those with the three lowest subendocardial MPRI values (MPRIsub3), are shown. The difference between regions with normal and reduced CFR was statistically significant (P < .001).

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 7: ROC curves of mean MPRI for segments with the three lowest transmural MPRI values (MPRItrans3) and mean MPRI for segments with the three lowest subendocardial MPRI values (MPRIsub3) for prediction of CFR of less than 2.00. The diagnostic accuracy of mean MPRI for segments with the three lowest subendocardial MPRI values (AUC, 0.85; sensitivity, 84%; specificity, 75%; cutoff value, 1.21) was better than that of mean MPRI for segments with the three lowest transmural MPRI values (AUC, 0.79; sensitivity, 79%; specificity, 58%; cutoff value, 1.33).