Rieber Johannes, Huber Armin, Erhard Isabelle, Mueller Silvia, Schweyer Michael, Koenig Andreas, Schiele Thomas M, Theisen Karl, Siebert Uwe, Schoenberg Stefan O, Reiser Maximilian, Klauss Volker
Department of Cardiology, Division of Internal Medicine, University of Munich Germany.
Eur Heart J. 2006 Jun;27(12):1465-71. doi: 10.1093/eurheartj/ehl039. Epub 2006 May 23.
Cardiac magnetic resonance perfusion imaging (CMRI) is a promising technique for non-invasive measurement of myocardial perfusion reserve. Fractional flow reserve (FFR) is an established invasive method for functional assessment of coronary artery disease (CAD). To prospectively assess the diagnostic value of CMRI for the detection of haemodynamically significant coronary lesions, compared with coronary angiography (CA) and FFR.
Forty-three patients with suspected or known CAD underwent CA, CMRI, and FFR measurement. First pass magnetic resonance perfusion examination was performed during hyperaemia (140 microg/kg/min adenosine over 6 min) and at rest. One hundred and twenty-nine perfusion territories were assessed by semi-quantitative evaluation of signal intensity-time curves using the myocardial perfusion reserve index (MPRI) [upslope(stress(corrected))/upslope(rest(corrected))]. Perfusion territories were categorized as normal (coronary stenosis < or = 50%), intermediate (stenosis > 50% and FFR > 0.75), or severe (stenosis > 50% and FFR < or = 0.75 or total occlusion). MPRI values (+/-SD) were significantly different between the three categories [normal, 2.2 +/- 0.5 vs. intermediate, 1.8 +/- 0.5 (P = 0.005) and intermediate vs. severe, 1.2 +/- 0.3 (P < 0.001)]. An MPRI cut-off value of 1.5 (derived from receiver operating characteristics analysis) distinguished haemodynamically relevant (severe) from non-relevant (normal and intermediate) stenoses with a sensitivity of 88% (CI 74-100%) and a specificity of 90% (CI 84-96%).
In contrast to earlier studies that compared CMRI with morphological examination (CA) alone, the present study compared CMRI with CA plus a standard invasive functional assessment (FFR) and demonstrated that CMRI is able to distinguish haemodynamically relevant from non-relevant coronary lesions with a high sensitivity and specificity and may therefore contribute to clinical decision-making.
心脏磁共振灌注成像（CMRI）是一种很有前景的用于无创测量心肌灌注储备的技术。血流储备分数（FFR）是一种已确立的用于评估冠状动脉疾病（CAD）功能的有创方法。为了前瞻性地评估CMRI检测血流动力学显著冠状动脉病变的诊断价值，并与冠状动脉造影（CA）和FFR进行比较。
43例疑似或已知CAD的患者接受了CA、CMRI和FFR测量。在充血（6分钟内静脉注射腺苷140μg/kg/min）和静息状态下进行首次通过磁共振灌注检查。通过使用心肌灌注储备指数（MPRI）[上斜率（应激（校正后））/上斜率（静息（校正后））]对信号强度-时间曲线进行半定量评估，对129个灌注区域进行评估。灌注区域分为正常（冠状动脉狭窄≤50%）、中度（狭窄＞50%且FFR＞0.75）或重度（狭窄＞50%且FFR≤0.75或完全闭塞）。这三类之间的MPRI值（±标准差）有显著差异[正常，2.2±0.5 vs. 中度，1.8±0.5（P = 0.005），中度 vs. 重度，1.2±0.3（P＜0.001）]。根据受试者工作特征分析得出的MPRI截断值为1.5，可区分血流动力学相关（重度）和非相关（正常和中度）狭窄，敏感性为88%（可信区间74 - 100%），特异性为90%（可信区间84 - 96%）。
与早期仅将CMRI与形态学检查（CA）进行比较的研究不同，本研究将CMRI与CA加上标准有创功能评估（FFR）进行了比较，结果表明CMRI能够以高敏感性和特异性区分血流动力学相关和非相关的冠状动脉病变，因此可能有助于临床决策。
