Author + information
- Received February 11, 2013
- Revision received August 19, 2013
- Accepted August 22, 2013
- Published online January 1, 2014.
- Federico E. Mordini, MD∗,†,
- Tariq Haddad, MD∗,
- Li-Yueh Hsu, DSc∗,
- Peter Kellman, PhD∗,
- Tracy B. Lowrey, RN∗,
- Anthony H. Aletras, PhD∗,‡,
- W. Patricia Bandettini, MD∗ and
- Andrew E. Arai, MD∗∗ ()
- ∗Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
- †Department of Cardiology, Veterans Affairs Medical Center, Washington, DC
- ‡Department of Biomedical Informatics, University of Central Greece, Lamia, Greece
- ↵∗Reprint requests and correspondence:
Dr. Andrew E. Arai, Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D 416, MSC 1061, 10 Center Drive, Bethesda, Maryland 20892-1061.
Objectives This study’s primary objective was to determine the sensitivity, specificity, and accuracy of fully quantitative stress perfusion cardiac magnetic resonance (CMR) versus a reference standard of quantitative coronary angiography. We hypothesized that fully quantitative analysis of stress perfusion CMR would have high diagnostic accuracy for identifying significant coronary artery stenosis and exceed the accuracy of semiquantitative measures of perfusion and qualitative interpretation.
Background Relatively few studies apply fully quantitative CMR perfusion measures to patients with coronary disease and comparisons to semiquantitative and qualitative methods are limited.
Methods Dual bolus dipyridamole stress perfusion CMR exams were performed in 67 patients with clinical indications for assessment of myocardial ischemia. Stress perfusion images alone were analyzed with a fully quantitative perfusion (QP) method and 3 semiquantitative methods including contrast enhancement ratio, upslope index, and upslope integral. Comprehensive exams (cine imaging, stress/rest perfusion, late gadolinium enhancement) were analyzed qualitatively with 2 methods including the Duke algorithm and standard clinical interpretation. A 70% or greater stenosis by quantitative coronary angiography was considered abnormal.
Results The optimum diagnostic threshold for QP determined by receiver-operating characteristic curve occurred when endocardial flow decreased to <50% of mean epicardial flow, which yielded a sensitivity of 87% and specificity of 93%. The area under the curve for QP was 92%, which was superior to semiquantitative methods: contrast enhancement ratio: 78%; upslope index: 82%; and upslope integral: 75% (p = 0.011, p = 0.019, p = 0.004 vs. QP, respectively). Area under the curve for QP was also superior to qualitative methods: Duke algorithm: 70%; and clinical interpretation: 78% (p < 0.001 and p < 0.001 vs. QP, respectively).
Conclusions Fully quantitative stress perfusion CMR has high diagnostic accuracy for detecting obstructive coronary artery disease. QP outperforms semiquantitative measures of perfusion and qualitative methods that incorporate a combination of cine, perfusion, and late gadolinium enhancement imaging. These findings suggest a potential clinical role for quantitative stress perfusion CMR.
- cardiac magnetic resonance
- myocardial ischemia
- myocardial perfusion
- quantitative perfusion
- stress testing
This study was funded by the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Arai receives research support from Siemens Medical Imaging (United States Government Cooperative Research and Development Award). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 11, 2013.
- Revision received August 19, 2013.
- Accepted August 22, 2013.
- American College of Cardiology Foundation