Myocardial Blood Flow Quantification Using Stress Cardiac Magnetic Resonance Improves Detection of Coronary Artery Disease

Figures

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  FIGURE 1. Stress CMR Protocol First-pass stress perfusion images are obtained following the administration of regadenoson or adenosine during the infusion of a gadolinium-based contrast agent (GBCA), followed by aminophylline if needed. Next, all functional images are acquired. Resting perfusion images are acquired approximately 15 minutes later during infusion of the GBCA. After an additional 5 minutes, LGE images are acquired. bSSFP = balanced steady-state free precession; CMR = cardiac magnetic resonance; LGE = late gadolinium enhancement; PSIR = phase-sensitive inversion recovery.

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  FIGURE 2. Perfusion Image Acquisition and Quantitative Perfusion Technique (A) Dual saturation-prepared sequence and typical slice positions. (B) Postprocessing steps for quantitative perfusion. AIF = arterial input function; ECG = electrocardiographic; MBF = myocardial blood flow; MYO = myocardium; PDW = proton density weighted.

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  FIGURE 3. Example of noCAD (A) Pixelwise MBF mapping at rest and during stress. (B) Signal intensity curves for AIF, basal, mid, and apical myocardium. (C) Rest myocardial blood flow (rMBF), stress myocardial blood flow (sMBF), and myocardial perfusion reserve (MPR) for each of the 16 American Heart Association segments shown as a bull’s-eye plot. (D) Method of MBF calculation for the segment-level, vessel level, and patient level. LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; noCAD = no obstructive coronary artery disease; RCA = right coronary artery; SI = signal intensity; other abbreviations as in Figure 2.

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  FIGURE 4. Effect Modification of the Association Between Global Mean MBF and obCAD at the Patient Level (A) Global mean sMBF and obstructive coronary artery disease (obCAD) for different clinical variables. (B) Global mean sMBF and obCAD for different technical variables. (C) Global mean MPR and obCAD for different clinical variables. (D) Global mean MPR and obCAD for different technical variables. 2RR = 2 R-R intervals; other abbreviations as in Figures 2 and 3.

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  FIGURE 5. Diagnostic Performance of QP and QA Receiver-operating characteristic (ROC) curve for mean sMBF, global mean MPR, and qualitative assessment (QA) for the detection of obCAD at the patient level (A) and at the coronary artery level (B). Curves A, B, C, and D in gray represent 4 experienced readers. The blue curve is the average ROC of the readers. AUC = area under the curve; QP = quantitative perfusion; other abbreviations as in Figures 3 and 4.

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  CENTRAL ILLUSTRATION. Diagnostic Performance of Quantitative Myocardial Blood Flow Analysis for the Detection of Obstructive Coronary Artery Disease AUC = area under the curve; LM = left main coronary artery; LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; MPR = myocardial perfusion reserve; noCAD = no obstructive coronary artery disease; obCAD = obstructive coronary artery disease; RCA = right coronary artery; sMBF = stress myocardial blood flow.