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CLINICAL STUDY: CARDIAC IMAGING

Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent

Christian M. Wacker, MD^*, Andreas W. Hartlep, PhD, Stefan Pfleger, MD, Lothar R. Schad, PhD, Georg Ertl, MD^* and Wolfgang R. Bauer, MD, PhD^*,*

^* Medical Clinic, University of Wuerzburg, Wuerzburg, Germany
Department of Biophysics and Medical Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
I. Medical Clinic Mannheim, University of Heidelberg, Mannheim, Germany

Manuscript received July 5, 2002; revised manuscript received September 24, 2002, accepted October 17, 2002.

^* Reprint requests and correspondence: Dr. Wolfgang R. Bauer, Medical Clinic, Department of Cardiology, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany.
w.bauer{at}medizin.uni-wuerzburg.de

OBJECTIVES: Evaluation of the severity of a coronary artery stenosis is of paramount importance for therapy. A relevant stenosis provokes post-stenotic microvascular dilation with capillary recruitment. This autoregulatory response was investigated in the present study by use of susceptibility-sensitive magnetic resonance imaging (MRI) without contrast agents.

BACKGROUND: Functional alterations of the microvascular system may be studied noninvasively and without a contrast agent by susceptibility-sensitive MRI, which is based on the paramagnetic property of deoxyhemoglobin. This effect, also referred to as the "blood oxygenation level-dependent (BOLD) effect," is investigated by phase relaxation (T₂*) measurements.

METHODS: In patients (n = 16) with single-vessel coronary artery disease, no history of myocardial infarction, normal left ventricular function at rest, and a positive stress echocardiogram, the susceptibility-sensitive parameter T₂* was assessed in the myocardium.

RESULTS: In regions associated with the stenotic artery, T₂* was significantly lower than in residual myocardium (p < 0.01). This difference in T₂* increased after application of the vasodilator dipyridamole (p < 0.001). In patients being re-investigated after therapeutic interventions, the microvascular dilation was partly removed.

CONCLUSIONS: For the first time, we could show that myocardial BOLD MRI detects post-stenotic capillary recruitment dependent on coronary artery stenosis.

Abbreviations and Acronyms   BOLD   blood oxygenation level-dependent   CABG   coronary artery bypass graft surgery   CAD   coronary artery disease   ECG   electrocardiographic   LAD   left anterior descending coronary artery   MRI   magnetic resonance imaging   PTCA   percutanous transluminal coronary angioplasty   ROI   region of interest   T2*   phase relaxation

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