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- Open Access
Impact of errors in determining the start of myocardial enhancement during quantitative first pass perfusion cardiovascular magnetic resonance imaging
© Ta et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Cardiovascular Magnetic Resonance
- Myocardial Blood Flow
- Significant Coronary Artery Disease
- Cardiovascular Magnetic Resonance Perfusion
Several studies have shown the potential of semi-quantitative and fully-quantitative analysis of cardiovascular magnetic resonance (CMR) perfusion images in the diagnosis of coronary artery disease (CAD). However, estimates of myocardial blood flow (MBF) rely on accurate selection of important timing parameters. In this study, we evaluate how the identification of the timing of the Start of Myocardial Enhancement (SME) affects MBF quantification. We hypothesize that incorrectly selecting the SME can adversely affect quantification of the MBF.
20 patients, including 10 with significant CAD (defined as ≥70% stenosis of a major epicardial artery on invasive coronary angiography), underwent regadenoson stress perfusion imaging using a steady-state free precession dual sequence technique followed by rest perfusion imaging. Motion corrected CMR perfusion images were quantified using model constrained deconvolution to obtain MBF estimates (in mL/min/g). Manual selection of SME was used as a reference start time. To evaluate how the timing of SME affects MBF, we systematically and intentionally shifted SME before and after the reference start time (-2, -1.5, -1, -0.5, 0.5, 1, 1.5, 2 second offsets were evaluated). A normal and a stenotic sector were identified from the myocardial signal intensity curves for each study with significant CAD.
This study demonstrates the importance of user-selected details when quantifying first pass myocardial perfusion. Selecting a timing point for SME that is the equivalent of one or two heart beats later than a reference standard results in a substantial overestimation of MBF, likely related to truncation of the myocardial time-intensity data. Truncation leads to overestimation of the initial contrast enhancement upslope particularly during stress. First pass CMR perfusion quantification should ensure that the onset of myocardial enhancement is properly detected.
ADT is supported by the Sarnoff Cardiovascular Research Foundation. CM is supported by the National Institutes of Health Research, UK. ADT, LH, HC, SW, KN, PK, SS, MC, PB, and AA are supported by the National Institutes of Health, USA.
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