Figure 4

Examples of concordances and discordances between coronary anatomy and myocardial blood flow (MBF) related to surface coil intensity correction (SCIC) method. Patient 1 has an 80% proximal LAD stenosis which is associated with reduced MBF in the anterior, anteroseptal, and anterolateral segments and well represented on the proton density weighted SCIC (PD-SCIC) pixel map. The perfusion defect is present but less obvious, on the saturation prepared steady-state free precession SCIC (SSFP-SCIC) pixel map. However on the pixel map quantified without SCIC (No-SCIC), MBF is erroneously highest in LAD territory and lower in the RCA territory. Patient 2 has an occluded dominant circumflex obtuse marginal artery and a 90% proximal LAD stenosis. All pixel maps show severely decreased MBF in the circumflex distribution. However, the No-SCIC pixel map shows erroneously increased MBF in the anterior wall. The PDSCIC and SSFP-SCIC depict expected low MBF in the LAD and circumflex territories. Patient 3 has a 75% ostial LAD stenosis. Low MBF is evident in the anteroseptum and anterior wall on the PD-SCIC and SSFP-SCIC pixel maps as expected. On the No-SCIC pixel map, MBF is erroneously highest in LAD territory and lower in the inferior and inferolateral walls. Patient 4 has an 80% proximal LAD stenosis and 80% mid RCA stenosis. The PD-SCIC and SSFP-SCIC pixel maps depict low MBF in keeping with LAD and RCA disease. While the No-SCIC pixel map correctly detects low MBF in the RCA territory, it misleadingly shows essentially normal LAD MBF. Patient 5 has a 75% proximal LAD stenosis. A subtle decrease in MBF is evident in the anteroseptum and anterior segment on the PD-SCIC pixel maps. This MBF abnormality is less obvious on the SSFPSCIC pixel map due to higher MBF heterogeneity. On the No-SCIC pixel map, MBF is erroneously highest in the anteroseptum and anterior wall, and incorrectly lowest in the inferior and lateral walls. Patient 6 has a 90% proximal LAD stenosis. A perfusion defect is evident in the anteroseptum and anterior segment on the PD-SCIC pixel map but less obvious on the SSFP-SCIC pixel map due to heterogeneity of MBF. On the No-SCIC pixel map, MBF erroneously appears lowest in the inferior wall.