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  • Oral presentation
  • Open Access

High-resolution versus standard-resolution cardiovascular magnetic resonance perfusion imaging for the detection of coronary artery disease

  • 1,
  • 1,
  • 1,
  • 2,
  • 3,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201214 (Suppl 1) :O89

https://doi.org/10.1186/1532-429X-14-S1-O89

  • Published:

Keywords

  • Coronary Artery Disease
  • Cardiovascular Magnetic Resonance
  • Invasive Coronary Angiography
  • Significant Coronary Artery Disease
  • Philips Healthcare

Summary

This study compared the diagnostic accuracy of high-resolution and standard-resolution cardiovascular magnetic resonance (CMR) perfusion imaging in patients with suspected coronary artery disease (CAD).

Background

Although accelerated high-spatial-resolution CMR perfusion imaging has recently been shown to be clinically feasible, there has not yet been a direct comparison with standard-resolution methods. We hypothesised that higher spatial resolution detects more subendocardial ischemia and leads to greater diagnostic accuracy for the detection of angiographically defined CAD.

Methods

A total of 111 patients with suspected CAD were prospectively recruited. All patients underwent two separate perfusion CMR studies on a 1.5 Tesla CMR scanner (Intera CV, Philips Healthcare, Best, the Netherlands), one with standard-resolution (2.5 x 2.5mm in-plane resolution) and one with high-resolution (1.6 x 1.6mm in-plane resolution) acquisition. High-resolution acquisition was facilitated by eight-fold k-t broad linear speed up technique (BLAST) acceleration. Two observers visually graded perfusion in each myocardial segment on a 4-point scale. Segmental scores were summed to produce a perfusion score for each patient. All patients underwent invasive coronary angiography. Significant CAD was defined as a coronary artery stenosis of ≥ 50% diameter on quantitative coronary angiography.

Results

CMR data were successfully obtained in 100 patients. A typical example is shown in Figure 1. In patients with CAD (n=70), more segments were determined to have subendocardial ischemia with high-resolution acquisition than with standard-resolution acquisition (279 vs.108; p<0.001). High-resolution acquisition had a greater diagnostic accuracy than standard-resolution acquisition for identifying single-vessel disease (area under the curve [AUC]: 0.88 vs. 0.73; p<0.001) or multi-vessel disease (AUC: 0.98 vs. 0.91; p=0.002) and overall (AUC: 0.93 vs. 0.83; p<0.001) (Figure 2).
Figure 1
Figure 1

Case Example Standard and high-resolution stress perfusion CMR images in a patient with three-vessel coronary artery disease. Standard-resolution shows perfusion defects (white arrows) in the basal inferior (A), mid inferior, mid inferoseptal (B), apical anterior and apical inferior segments (C). High-resolution shows a similar distribution of perfusion defects but demonstrates additional ischemia in the basal lateral (D), mid anterior and mid anterolateral segments (E) with a circumferential defect in the apical slice (F). Perfusion defects are also better delineated at high-resolution and the transmural extent of ischemia more clearly seen.

Figure 2
Figure 2

Receiver-Operator Characteristic Curves. Standard and high-resolution perfusion CMR both had a high diagnostic accuracy for the detection of coronary artery disease but the high-resolution technique was superior. The areas under the curve were 0.83 (95% CI: 0.75-0.91) for standard-resolution and 0.93 (95% CI: 0.88-0.98) for high-resolution (p<0.001).

Conclusions

Our study shows that high-resolution CMR perfusion imaging has greater diagnostic accuracy than standard-resolution acquisition for the detection of CAD in both single and multi-vessel disease and detects more subendocardial ischemia.

Funding

S.P is funded by a British Heart Foundation fellowship (FS/10/62/28409).

S.P and J.P.G received an unrestricted educational research grant from Philips Healthcare.

Authors’ Affiliations

(1)
Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
(2)
Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
(3)
NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK

Copyright

© Motwani et al; licensee BioMed Central Ltd. 2012

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.

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