Volume 13 Supplement 1

Abstracts of the 2011 SCMR/Euro CMR Joint Scientific Sessions

Open Access

Myocardial ASL perfusion reserve test detects ischemic segments in initial cohort of 10 patients with angiographic CAD

  • Zungho Zun1,
  • Terrence Jao1,
  • Ning Smith2,
  • Padmini Varadarajan3,
  • Ramdas G Pai3,
  • Eric C Wong4 and
  • Krishna S Nayak1
Journal of Cardiovascular Magnetic Resonance201113(Suppl 1):P110

DOI: 10.1186/1532-429X-13-S1-P110

Published: 2 February 2011


This study sought to demonstrate the potential for myocardial arterial spin labeling (ASL) to identify the ischemic myocardial segments due to stenosis in coronary arteries as detected by X-ray angiography.


Myocardial ASL is a technique for the assessment of myocardial blood flow (MBF) without contrast agents. It can be safely applied to patients with end-stage renal disease who are not candidates for first-pass imaging with contrast agents. Myocardial ASL perfusion imaging performed at rest and during adenosine stress provides perfusion reserve (MBFstress/MBFrest), which is a common indicator for the severity of coronary artery disease. In healthy myocardium, perfusion reserve is known to be approximately four [1].


Twenty nine patients were recruited from those scheduled for routine cardiac MR (CMR) and X-ray angiography. Myocardial ASL measurements were obtained from a single mid short-axis slice at rest and during adenosine infusion (dosage: 0.14 mg/kg/min) on a GE Signa 3T scanner. The ASL sequence was composed of flow-sensitive alternating inversion recovery (FAIR) tagging and balanced steady-state free precession (SSFP) imaging [2]. Perfusion reserve maps were generated in a standard short-axis view illustration by convolution with a Gaussian filter and resampling onto a polar coordinate [3].


Ten of the twenty-nine patients were found to have significant stenosis on X-ray angiography. Table 1 contains the most ischemic myocardial segments in these ten patients as identified by two cardiologists using either X-ray angiogram or ASL perfusion reserve map independently. Based on McNemar’s test with Bonferroni correction, there was no significant difference between X-ray and ASL MRI in identifying ischemia in all six myocardial segments (p = 1.0000, 0.6170, 0.4795, 0.1336, 0.4795, and 0.4795). Figure 1 contains perfusion reserve maps acquired using myocardial ASL in these patients. The average standard deviation of physiological noise was 0.22 ml/g/min at rest and 0.42 ml/g/min during stress [2].
Table 1

Most ischemic myocardial segments identified by X-ray angiograms and by ASL perfusion reserve maps

Pts #

X-ray angiography



Worst lesion on angiogram

Ischemic myocardial segments

Ischemic myocardial segments


Proximal LAD 100%




RCA 100%

Inferior, inferolateral



LAD 90%


Anterior, anteroseptal


LCS 90% (PDA)

Inferoseptal, inferior, inferolateral

Inferoseptal, inferior


RCA (100%)

Inferoseptal, inferior

Anteroseptal, inferoseptal, inferior


RCA (100%)

Inferoseptal, inferior



Distal RCA 80%




Stent to LAD and RCA – now open

Anteroseptal, inferoseptal



LCX 100%, RCA 100%

Inferior, inferolateral, anterolateral



RCA 100%

Inferior, inferolateral


Figure 1

Perfusion reserve maps acquired using myocardial ASL in patients 1-10. Asterisks denote the most ischemic segments identified based on X-ray angiography.


There was visual agreement (except patients 7, 8, and 10) and no statistically significant difference between ischemic myocardial segments identified by ASL perfusion reserve maps and by X-ray angiograms. This suggests that myocardial ASL with vasodilation may have a potential to identify ischemic myocardial segments in patients with stenosis.

Authors’ Affiliations

University of Southern California
Kaiser Permanente Southern California
Loma Linda University Medical Center
University of California


  1. Kaufmann : Am J Physiol Heart Circ Physiol. 2007Google Scholar
  2. Zun : MRM. 2009Google Scholar
  3. Jao : US patent (pending)


© Zun et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.