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Diagnostic Performance of Myocardial Perfusion MR at 3 T in Patients with Coronary Artery Disease¹

¹ From the Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany (R.G., C.J., I.P., S.K., E.F., E.N.); and Clinical Science, Philips Medical Systems, Hamburg, Germany (B.S.). Received March 31, 2007; revision requested May 31; revision received July 30; accepted August 20; final version accepted September 24. Address correspondence to R.G. (e-mail: gebker{at}dhzb.de).

Purpose: To prospectively determine the diagnostic performance of myocardial perfusion magnetic resonance (MR) imaging at 3 T for helping depict clinically relevant coronary artery stenosis (50% diameter) in patients with suspected or known coronary artery disease (CAD), with coronary angiography as the reference standard.

Materials and Methods: The study was approved by the local ethics committee; written informed consent was obtained. Vasodilator stress perfusion imaging by using a turbo field-echo sequence was obtained in 101 patients (71 men, 30 women; mean age, 62 years ± 7.7 [standard deviation]) scheduled for coronary angiography. Myocardial ischemia was defined as stress-inducible perfusion deficit in arterial territories without delayed enhancement (DE) or additional stress-inducible perfusion deficit in territories with nontransmural DE. Images were evaluated in consensus by two blinded readers. Diagnostic performance was determined on per-patient and per–coronary artery territory bases. The number of dark rim artifacts in patients without DE was determined in a second read. Interobserver variability was assessed in 40 randomly selected patients.

Results: One hundred one patients underwent MR examinations. Coronary angiography depicted relevant stenosis in 70 (69%) patients. Patient-based sensitivity and specificity were 90% and 71%, respectively. Sensitivity, specificity, and diagnostic accuracy for the detection of coronary stenosis in a specific territory were 76%, 89%, and 86%, respectively. In 24% of patients without DE, dark rim artifacts were detected, mostly in the left anterior descending artery territory (56%). In 40 randomly selected patients, there was agreement in the determination of myocardial perfusion deficits in 37 (93%, = 0.79) patients.

Conclusion: Myocardial perfusion MR imaging by using saturation-recovery spoiled gradient-echo imaging at 3 T has an accuracy of 84% for depicting hemodynamically relevant coronary artery stenosis in patients with suspected and known CAD.

© RSNA, 2008