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Use of T2 maps for rapid prediction of stress effectiveness before the injection of contrast in myocardial perfusion studies at 3.0T
© Fernandes et al. 2016
- Published: 27 January 2016
- Perfusion Image
- Short Axis Slice
- Post Stress
- Myocardial Perfusion Study
Effective induction of vasodilation during stress perfusion CMR exams may not occur in a clinically significant proportion of patients. While visual analysis of splenic switch-off may offer an accurate assessment of stress adequacy, it can only be analyzed retrospectively. T2 maps may detect stress vasodilatory changes preemptively and allow changes to the protocol prior to contrast injection.
Fifty patients undergoing routine stress CMR exams with dipyridamole and a FLASH perfusion sequence were prospectively studied at 3.0 T (Siemens Verio). A single breath-hold myocardial T2 map (TrueFISP sequence, 3 T2 preparation pulses, 9 total heartbeats) of a mid-ventricular short axis slice was obtained using a prototype sequence at rest and immediately after dipyridamole injection, followed by routine perfusion images. T2 values pre and post stress were measured in a ROI of the septum in the inline generated maps. Peak signal intensity (PSI, maximum minus baseline values) of the myocardium in the same region as well in the spleen were calculated. Spleen switch-off was determined visually and semi-quantitatively. Statistical analysis included correlations of the percentage changes of T2 in comparison to differences in spleen PSI and spleen-to-myocardial ratios. ROC curves were used to calculate the accuracy of T2 values to determine the presence of spleen switch-off.
Use of T2 maps pre and post stress induction predicts the occurrence of splenic switch-off before the acquisition of perfusion images and may allow for changes in management of the stress protocol improving exam efficacy.
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