Abstract
Purpose: The purpose of this study is to assess the reliability of multislice MR perfusion imaging in comparison to regional wall function and nuclear medicine and to test different qualitative and quantitative parameters for perfusion assessment. Material and methods: 15 patients with chronic myocardial ischemia underwent CINE and first-pass perfusion MR imaging. Functional myocardial imaging was performed using a segmented CINE FLASH sequence and systolic myocardial wall thickening was assessed after semiautomated segmentation. MR first-pass perfusion studies were performed using a multislice saturation recovery TurboFLASH sequence. Different parameters were calculated for assessment of hypoperfused segments and results of MR imaging compared to 99mTc-SestaMIBI SPECT. Results: MR perfusion imaging showed a sensitivity of 72% and a specificity of 98%. In combination with MR CINE imaging and wall thickening analysis we calculated a sensitivity of 100% and a specificity of 93%. Qualitative and quantitative perfusion parameter analysis showed significant differences between normal and hypoperfused segments for the signal intensity increase (p < 0.001), the signal intensity upslope (p < 0.001) as well as for the myocardial mean transit time (p < 0.001). Conclusion: The combination of systolic wall thickening analysis and myocardial perfusion can markedly improve the sensitivity of MRI in depiction of LV myocardial perfusion abnormalities. For assessment of hypoperfusion, different quantitative and qualitative parameters can be calculated showing significant differences between normal state and hypoperfusion.
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Atkinson DJ, Burstein D, Edelman RR. First-pass cardiac perfusion: evaluation with ultrafast MR imaging. Radiology 1990; 174: 757–762.
Manning WJ, Atkinson DJ, Grossman W, Paulin S, Edelman RR. First-pass nuclear magnetic resonance imaging studies using gadolinium-DTPA in patients with coronary artery disease. J Am Coll Cardiol 1991; 18: 959–965.
Matheijssen NA, Louwerenburg HW, van Rugge FP, et al. Comparison of ultrafast dipyridamole magnetic resonance imaging with dipyridamole SestaMIBI SPECT for detection of perfusion abnormalities in patients with one-vessel coronary artery disease: assessment by quantitative model fitting. Magn Reson Med 1996; 35: 221–228.
Wilke N, Jerosch-Herold M, Stillman AE, et al. Concepts of myocardial perfusion imaging in magnetic resonance imaging. Magn Reson Q 1994; 10: 249–286.
Bremerich J, Buser P, Bongartz G, et al. Noninvasive stress testing of myocardial ischemia: comparison of GRE-MRI perfusion and wall motion analysis to 99 mTc-MIBI-SPECT, relation to coronary angiography. Eur Radiol 1997; 7: 990–995.
Wilke N, Jerosch-Herold M, Wang Y, et al. Myocardial perfusion reserve: assessment with multisection, quantitative, first-pass MR imaging. Radiology 1997; 204: 373–384.
Baer FM, Voth E, Schneider CA, Theissen P, Schicha H, Sechtem U. Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with [18F]fluorodeoxyglucose in patients with chronic coronary artery disease. A functional and morphological approach to the detection of residual myocardial viability. Circulation 1995; 91: 1006–1015.
van Rugge FP, van der Wall EE, Spanjersberg SJ, et al. Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease. Quantitative wall motion analysis using a modification of the centerline method. Circulation 1994; 90: 127–138.
Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo HW. Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 1986; 74: 293–305.
Penzkofer H, Wintersperger BJ, Knez A, Weber J, Reiser M. Assessment of myocardial perfusion using multisection first-pass MRI and color-coded parameter maps: a comparison to 99mTc Sesta MIBI SPECT and systolic myocardial wall thickening analysis. Magn Reson Imaging 1999; 17: 161–170.
Penzkofer H, Wintersperger B, Smekal A, et al. Qualitative und quantitative Bestimmung der regionalen Myokardperfusion mittels Magnetresonanztomographie. Radiologe 1997; 37: 372–377.
Zierler K. Theoretical basis of indicator-dilution methods for measuring flow and volume. Circulation Research 1962; 10: 393–407.
Clough AV, al-Tinawi A, Linehan JH, Dawson CA. Regional transit time estimation from image residue curves. Ann Biomed Eng 1994; 22: 128–143.
Wilke N, Simm C, Zhang J, et al. Contrast-enhanced first pass myocardial perfusion imaging: correlation between myocardial blood flow in dogs at rest and during hyperemia. Magn Reson Med 1993; 29: 485–497.
Lombardi M, Jones RA, Westby J, et al. MRI for the evaluation of regional myocardial perfusion in an experimental animal model. J Magn Reson Imaging 1997; 7: 987–995.
Hartnell G, Cerel A, Kamalesh M, et al. Detection of myocardial ischemia: value of combined myocardial perfusion and cineangiographic MR imaging. Am J Roentgenol 1994; 163: 1061–1067.
Wilson RF. Assessing the severity of coronary-artery stenoses. N Engl J Med 1996; 334: 1735–1737.
Jerosch-Herold M, Wilke N. MR first pass imaging: quantitative assessment of transmural perfusion and collateral flow. Int J Card Imaging 1997; 13: 205–218.
Wacker FJT. Artifacts in plain and SPECT myocardial perfusion imaging. Am J Card Imaging 1992; 6: 42–58.
Schwitter J, Debatin JF, von Schulthess GK, McKinnon GC. Normal myocardial perfusion assessed with multishot echo-planar imaging. Magn Reson Med 1997; 37: 140–147.
Lassen NA, Perl W. Tracer kinetic methods in medical physiology. New York: Raven Press, 1979.
Keijer JT, van Rossum AC, van Eenige MJ, et al. Semiquantitation of regional myocardial blood flow in normal human subjects by first-pass magnetic resonance imaging. Am Heart J 1995; 130: 893–901.
Weissko. RM, Chesler D, Boxerman JL, Rosen BR. Pitfalls in MR measurement of tissue blood flow with intravascular tracers: which mean transit time? Magn Reson Med 1993; 29: 553–558.
Vassanelli C, Menegatti G, Molinari J, et al. Maximal myocardial perfusion by videodensitometry in the assessment of the early and late results of coronary angioplasty: relationship with coronary artery measurements and left ventricular function at rest. Cathet Cardiovasc Diagn 1995; 34: 301–310; discussion 311–302.
Ismail S, Jayaweera AR, Camarano G, Gimple LW, Powers ER, Kaul S. Relation between air-filled albumin micro-bubble and red blood cell rheology in the human myocardium. Influence of echocardiographic systems and chest wall attenuation. Circulation 1996; 94: 445–451.
Judd RM, Lugo-Olivieri CH, Arai M, et al. Physiological basis of myocardial contrast enhancement in fast magnetic resonance images of 2-day-old reperfused canine infarcts. Circulation 1995; 92: 1902–1910.
Pereira RS, Prato FS, Sykes J, Wisenberg G. Assessment of myocardial viability using MRI during a constant infusion of Gd-DTPA: further studies at early and late periods of reperfusion. Magn Reson Med 1999; 42: 60–68.
Kim RJ, Chen EL, Lima JA, Judd RM. Myocardial Gd-DTPA kinetics determine MRI contrast enhancement and reflect the extent and severity of myocardial injury after acute reperfused infarction. Circulation 1996; 94: 3318–3326.
Rogers WJ Jr., Kramer CM, Geskin G, et al. Early contrast-enhanced MRI predicts late functional recovery after reperfused myocardial infarction. Circulation 1999; 99: 744–750.
Ramani K, Judd RM, Holly TA, et al. Contrast magnetic resonance imaging in the assessment of myocardial viability in patients with stable coronary artery disease and left ventricular dysfunction. Circulation 1998; 98: 2687–2694.
Dendale P, Franken PR, Block P, Pratikakis Y, De Roos A. Contrast enhanced and functional magnetic resonance imaging for the detection of viable myocardium after infarction. Am Heart J 1998; 135: 875–880.
Dendale P, Franken PR, Holman E, Avenarius J, van der Wall EE, de Roos A. Validation of low-dose dobutamine magnetic resonance imaging for assessment of myocardial viability after infarction by serial imaging. Am J Cardiol 1998; 82: 375–377.
Baer FM, Voth E, LaRosee K, et al. Comparison of dobutamine transesophageal echocardiography and dobutamine magnetic resonance imaging for detection of residual myocardial viability. Am J Cardiol 1996; 78: 415–419.
Baer FM, Theissen P, Schneider CA, et al. Dobutamine magnetic resonance imaging predicts contractile recovery of chronically dysfunctional myocardium after successful revascularization. J Am Coll Cardiol 1998; 31: 1040–1048.
Sechtem U, Sommerhoff BA, Markiewicz W, White RD, Cheitlin MD, Higgins CB. Regional left ventricular wall thickening by magnetic resonance imaging: evaluation in normal persons and patients with global and regional dysfunction. Am J Cardiol 1987; 59: 145–151.
van der Geest RJ, Buller VG, Jansen E, et al. Comparison between manual and semiautomated analysis of left ventricular volume parameters from short-axis MR images. J Comput Assist Tomogr 1997; 21: 756–765.
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Wintersperger, B.J., Penzkofer, H.V., Knez, A. et al. Multislice MR perfusion imaging and regional myocardial function analysis: complimentary findings in chronic myocardial ischemia. Int J Cardiovasc Imaging 15, 425–434 (1999). https://doi.org/10.1023/A:1006390704517
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DOI: https://doi.org/10.1023/A:1006390704517