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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

Assessment of coronary flow reserve: comparison between contrast-enhanced magnetic resonance imaging and positron emission tomography

Tareq Ibrahim, MD^*, Stephan G. Nekolla, PhD^*, Karin Schreiber, MD^*, Kenichi Odaka, MD^*, Stefan Volz, MD, Julinda Mehilli, MD, Martin Güthlin, MD, Wolfram Delius, MD and Markus Schwaiger, MD, FACC^*,*

^* Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Munich, Germany
Kardiologische Abteilung Krankenhaus München-Bogenhausen, Munich, Germany
Deutsches Herzzentrum München und 1. Medizinische Klinik der Technischen Universität München, Munich, Germany

Manuscript received January 10, 2001; revised manuscript received November 29, 2001, accepted December 14, 2001.

^* Reprint requests and correspondence: Dr. Markus Schwaiger, Nuklearmedizinische Klinik der Technischen Universität München, Ismaningerstr. 22, D 81675 Munich, Germany.
m.schwaiger{at}lrz.tu-muenchen.de

OBJECTIVES: The study compared flow reserve indices by magnetic resonance imaging (MRI) with quantitative measures of coronary angiography and positron emission tomography (PET).

BACKGROUND: The noninvasive evaluation of myocardial flow by MRI has recently been introduced. However, a comparison to quantitative flow measurement as assessed by PET has not been reported in patients with coronary artery disease (CAD).

METHODS: Two groups of healthy volunteers and 25 patients with angiographically documented CAD were examined by MRI and PET at rest and during adenosine stress. Dynamic MRI was performed using a multi-slice ultra-fast hybrid sequence and a rapid gadolinium-diethylenetriaminepenta-acetic acid bolus injection (0.05 mmol/l). Upslope and peak-intensity indices were regionally determined from first-pass signal intensity curves and compared to N-13 ammonia PET flow reserve measurements.

RESULTS: In healthy volunteers, the upslope analysis showed a stress/rest index of 2.1 ± 0.6, which was higher than peak intensity (1.5 ± 0.3), but lower than flow reserve by PET (3.9 ± 1.1). Localization of coronary artery stenoses (>75%, MRI <1.2), based on the upslope index, yielded sensitivity, specificity and diagnostic accuracy of 69%, 89% and 79%, respectively. Upslope index correlated with PET flow reserve (r = 0.70). A reduced coronary flow reserve (PET <2.0, MRI <1.3) was detected by the upslope index with sensitivity, specificity and diagnostic accuracy of 86%, 84% and 85%, respectively.

CONCLUSIONS: Magnetic resonance imaging first-pass perfusion measurements underestimate flow reserve values, but may represent a promising semi-quantitative technique for detection and severity assessment of regional CAD.

Abbreviations and Acronyms   Gd-DTPA   CAD   coronary artery disease   CFR   coronary flow reserve   Gd-DTPA   gadolinium-diethylenetriaminepenta-acetic acid   LAD   left anterior descending   LCX   left circumflex   LV   left ventricle/ventricular   MI   myocardial infarction   MRI   magnetic resonance imaging   PET   positron emission tomography   RCA   right coronary artery   ROC   receiver operating characteristic   ROI   regions of interest   SI   signal intensity

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