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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

View larger version (78K): [in a new window]   Figure 1 Example of a patient with single-vessel disease (left circumflex stenosis, 78%) resulting in hypoperfusion of the lateral wall under stress condition in a representative slice. From top to bottom, the inflow of magnetic resonance imaging contrast agent, the parametric overlay of maximal upslope together with a matched positron emission tomography short-axis image, is shown. In the bottom row, two signal intensity curves (as marked in the parametric image) are shown. In this particular example, both upslope and uptake are significantly reduced in the lateral wall. a.u. = arbitrary units.

View larger version (15K): [in a new window]   Figure 2 Comparison of upslope (solid square) and peak intensity (triangle) magnetic resonance imaging (MRI) indices with the (a) severity of coronary artery stenosis and (b) the coronary flow reserve in positron emission tomography (PET).

View larger version (28K): [in a new window]   Figure 3 The receiver operating characteristic analysis using varying magnetic resonance imaging (MRI) upslope and peak-intensity flow indices as threshold for the detection of severe coronary artery stenosis (>75%) (a) and reduced coronary flow reserve by positron emission tomography (PET) (<2.0) (b). AUC = area under the curve; Sens. = sensitivity; Spec. = specificity.

View larger version (15K): [in a new window]   Figure 4 Correlation of magnetic resonance imaging (MRI) peak-intensity index (a) and upslope index (b) with positron emission tomography (PET) measurements of coronary flow reserve in different vascular segments. Circle = left anterior descending; square = left circumflex; triangle = right coronary artery.