Reproducibility of First Pass Perfusion CMR at rest and during hyperaemia for estimation of myocardial perfusion

Q: What is the clinical evidence from this study?

Population: Healthy volunteers undergoing myocardial perfusion assessment (n=11). Intervention: First-pass perfusion cardiovascular magnetic resonance (CMR) during adenosine-induced hyperaemia and at rest vs. Semi-quantitative analysis (maximal upslopes/MPI) vs fully quantitative analysis (Fermi function deconvolution); intraobserver, interobserver, and interstudy comparisons. Primary outcome: Reproducibility of semi-quantitative (myocardial perfusion index [MPI] and myocardial perfusion reserve index [MPRI]) and quantitative (absolute myocardial blood flow in ml/g/min) CMR perfusion estimates.

Q: What does this research mean for the field?

First-pass perfusion CMR provides good global reproducibility for myocardial perfusion estimates at rest and during hyperaemia, with semi-quantitative analysis demonstrating higher reproducibility than fully quantitative analysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Abdulghani M Larghat; Aleksandra Radjenovic; Neil Maredia; John Biglands; John P. Greenwood; Sven Plein

doi:10.1186/1532-429x-12-s1-p228

January 1, 2010Journal of Cardiovascular Magnetic ResonanceOpen Access

Reproducibility of First Pass Perfusion CMR at rest and during hyperaemia for estimation of myocardial perfusion

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Key result

Semi-quantitative first-pass perfusion CMR shows superior reproducibility compared to fully quantitative analysis.

n=11

Why the study?

Reproducibility data for first-pass CMR perfusion estimates are sparse, yet such data are needed to monitor the response to therapies that affect myocardial blood flow.

What is the intraobserver, interobserver, and interstudy reproducibility of semi-quantitative and fully quantitative myocardial blood flow estimation from first-pass perfusion CMR at rest and during adenosine-induced hyperaemia?

Key Points

To assess the reproducibility of myocardial blood flow estimates derived from first-pass perfusion cardiovascular magnetic resonance (CMR) at rest and during adenosine-induced hyperaemia.
11 volunteers (6 males, mean age 33 ± 7 years) underwent CMR perfusion scanning on 2 separate days (mean interstudy delay = 84 ± 111 days, median delay = 7 days) on a 1.5 T system at rest and during adenosine hyperaemia (140 mcg/kg/min, 0.05 mmol/kg Gd-DTPA).
Perfusion was measured from a single systolic midventricular slice to calculate the myocardial perfusion index (MPI) and myocardial perfusion reserve index (MPRI).
Fermi function deconvolution calculated absolute myocardial blood flow; intraobserver reproducibility was retested at 4 weeks alongside blinded interobserver analysis.
All measurements demonstrated good reproducibility of global CMR perfusion estimates.
Reproducibility was highest for intraobserver comparisons, followed by interobserver comparisons (particularly in stress studies), and was lowest for interstudy comparisons.
Semiquantitative measurements were generally more reproducible than fully quantitative analysis.

Structured PICO

What is the intraobserver, interobserver, and interstudy reproducibility of semi-quantitative and fully quantitative myocardial blood flow estimation from first-pass perfusion CMR at rest and during adenosine-induced hyperaemia?

P

Population

11 volunteers (mean age 33 ± 7 years, 6 males) who underwent first-pass cardiovascular magnetic resonance (CMR) perfusion on two separate days with a mean interstudy delay of 84 ± 111 days (median 7 days).

I

Intervention

First-pass perfusion CMR on a 1.5 T Philips Intera system during intravenous adenosine-induced hyperaemia (140 mcg/kg/min, 0.05 mmol/kg Gd-DTPA) and at rest, analyzed via semi-quantitative (MASS 6.0) and fully quantitative (Fermi function deconvolution) methods.

C

Comparator

Repeat scan on a separate day (interstudy comparison), repeat analysis after 4 weeks by the same observer (intraobserver comparison), and separate blinded analysis by a second observer (interobserver comparison).

O

Outcome

Reproducibility (intraobserver, interobserver, and interstudy) of semi-quantitative myocardial perfusion index (MPI), myocardial perfusion reserve index (MPRI), and quantitative absolute myocardial blood flow (ml/g/min).surrogate

First-pass perfusion CMR provides reproducible global myocardial perfusion estimates at rest and during adenosine stress, with semi-quantitative analysis showing superior reproducibility compared to fully quantitative Fermi deconvolution.

Limitations

Cumulative variability of segmentation and subsequent Fermi-deconvolution with user input at both stages

Ask about this paper

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Implication

Supports semi-quantitative first-pass perfusion CMR in research; leaves open standardization of quantitative methods before clinical use.

Abstract

Methods 11 volunteers (6 males, mean age 33 ± 7 years) underwent CMR perfusion on 2 separate days (mean interstudy delay = 84 ± 111 days, median delay = 7 days) on a 1.5 T Philips Intera system during adenosine-induced hyperaemia (140 mcg/kg/min, 0.05 mmol/kg Gd-DTPA) and rest. A pulse sequence optimised for acquisition of a single midventricular slice at systole was used (saturation recovery segmented gradient echo, 2 × SENSE TR/TE/flip 2.7 ms/1.0/ 15°, typical FOV 380 × 380 mm, matrix 160 × 160, slice thickness 10 mm, preparation pulse delay 150 ms, shot duration 130 ms). Endoand epicardial contours were drawn. "Semi"-quantitative analysis calculated maximal upslopes of myocardial signal intensity of the entire slice, normalised to the LV blood-pool (Myocardial perfusion index, MPI) using MASS 6.0 (Medis, Leiden, The Netherlands). The myocardial perfusion reserve index (MPRI) was calculated as the ratio of hyperaemic over rest MPI.

Discussion

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Cite This Study

Larghat et al. (2010) studied Healthy volunteers undergoing myocardial perfusion assessment (n=11). First-pass perfusion cardiovascular magnetic resonance (CMR) during adenosine-induced hyperaemia and at rest vs. Semi-quantitative analysis (maximal upslopes/MPI) vs fully quantitative analysis (Fermi function deconvolution); intraobserver, interobserver, and interstudy comparisons was evaluated on Reproducibility of semi-quantitative (myocardial perfusion index [MPI] and myocardial perfusion reserve index [MPRI]) and quantitative (absolute myocardial blood flow in ml/g/min) CMR perfusion estimates. First-pass perfusion CMR demonstrated good global reproducibility at rest and during hyperaemia, with semi-quantitative measurements being generally more reproducible than fully quantitative analysis.

synapsesocial.com/papers/6a725ab0ce524a4339c5655f https://doi.org/10.1186/1532-429x-12-s1-p228

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Reproducibility of First Pass Perfusion CMR at rest and during hyperaemia for estimation of myocardial perfusion

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Reproducibility of First Pass Perfusion CMR at rest and during hyperaemia for estimation of myocardial perfusion

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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