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Quantitative whole-heart three-dimensional magnetic resonance myocardial perfusion imaging in systole and diastole at 3.0T
Journal of Cardiovascular Magnetic Resonance volume 15, Article number: P206 (2013)
Two-dimensional (2D) perfusion-CMR has been shown to have greater diagnostic accuracy than single-photon emission computed tomography but remains limited by a lack of complete myocardial coverage. Three-dimensional (3D) whole-heart myocardial perfusion CMR addresses this limitation and has recently been shown to be clinically feasible. However, the feasibility and potential clinical utility of quantitative 3D perfusion measurements, as already shown with 2D-perfusion-CMR and positron emission tomography, has yet to be evaluated. The purpose of this study was to establish the feasibility of quantitative 3D-perfusion-CMR to detect coronary artery disease (CAD). Additionally, as 3D-perfusion-CMR offers the opportunity to select the phase of acquisition, a secondary objective was to determine differences between systolic and diastolic estimates of myocardial blood flow (MBF).
35 patients underwent 3D-perfusion-CMR (Philips 3T Achieva TX) with data acquired at both end-systole and mid-diastole (Fig 1). Systolic and diastolic perfusion images were analyzed in separate reporting sessions in random order. Image quality (0=non-diagnostic, 1=poor, 2=adequate and 3=excellent) and the occurrence of artifact related to respiratory-motion, k-t reconstruction or dark-rim artifact (0=none, 1=mild, 2=moderate and 3=severe) were scored. MBF and myocardial perfusion reserve (MPR) were estimated on a per patient and per territory basis by Fermi function deconvolution. CAD was defined as luminal stenosis ≥70% on quantitative coronary angiography.
38 coronary territories had significant CAD. MPR had a high diagnostic accuracy for the detection of CAD, in both systole and diastole (area under curve: 0.92 vs. 0.94; p=0.41) (Fig 2). At rest, systolic and diastolic MBF estimates were similar - in both normal and diseased territories (no CAD: 1.24 ± 0.15 vs. 1.25 ± 0.15ml/g/min, p=0.27; CAD: 1.24 ± 0.15 vs. 1.26 ± 0.14ml/g/min, p=0.20). At stress, diastolic MBF estimates were significantly greater than systolic estimates (no CAD: 3.21 ± 0.50 vs. 2.75 ± 0.42ml/g/min, p<0.0001; CAD: 2.13 ± 0.45 vs. 1.98 ± 0.41ml/g/min, p<0.0001). The diastolic/systolic stress MBF ratio was significantly reduced in territories with CAD (CAD: 1.08 ± 0.06 vs. no CAD: 1.17 ± 0.11; p<0.0001). Systolic acquisition had a higher overall image quality score (median: 3 vs. 2, p=0.002) and was less prone to artifact than diastolic acquisition (median artifact score: 0 vs. 1; p<0.0001). In particular, there was a greater frequency of dark-rim artifact in diastole compared to systole (19 vs. 9 patients).
We have shown that quantitative 3D-perfusion-CMR is feasible and can be used to detect CAD with high diagnostic accuracy. Image quality and less artifact, make systole the preferred phase for acquisition in 3D-perfusion-CMR. Finally, there were significant differences in systolic and diastolic MBF estimates and therefore the phase of acquisition should always be stated in future quantitative studies.
JPG and SP receive an educational research grant from Philips Healthcare. SP is funded by a BHF fellowship (FS/1062/28409).
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Motwani, M., Kidambi, A., Fairbairn, T. et al. Quantitative whole-heart three-dimensional magnetic resonance myocardial perfusion imaging in systole and diastole at 3.0T. J Cardiovasc Magn Reson 15, P206 (2013). https://doi.org/10.1186/1532-429X-15-S1-P206
- Coronary Artery Disease
- Myocardial Perfusion Imaging
- Myocardial Blood Flow
- Myocardial Perfusion Reserve
- Image Quality Score