Barmeyer Achim A, Stork Alexander, Muellerleile Kai, Tiburtius Claudia, Schofer Anne K, Heitzer Thomas A, Hofmann Thomas, Adam Gerhard, Meinertz Thomas, Lund Gunnar K
Clinic of Cardiology/Angiology, Heart Center, University Hospital Hamburg-Eppendorf, Martini-strasse 52, 20246 Hamburg, Germany.
Radiology. 2007 May;243(2):377-85. doi: 10.1148/radiol.2432060331.
To prospectively evaluate the accuracy of contrast material-enhanced cardiac magnetic resonance (MR) imaging for determining impaired coronary flow velocity reserve (CFR) by using Doppler flow measurement as the reference standard.
The study was approved by the institutional ethics committee, and all patients gave written informed consent. Eligible patients underwent contrast-enhanced cardiac MR imaging and invasive measurement of CFR. For contrast-enhanced MR imaging, a three-section single-shot saturation recovery gradient-recalled echo sequence with steady-state free precession was used. Sections were divided into six segments. For each segment, a transmural and subendocardial myocardial perfusion reserve index (MPRI) was calculated by using the upslope of the signal intensity-time curve during the first pass of contrast material at rest and during adenosine infusion (140 microg per kilogram body weight per minute). MPRIs of vascular regions were compared with the corresponding CFR. Receiver operating characteristic (ROC) analysis was performed to find the number of segments needed for best diagnostic accuracy of MPRI and to find a cutoff value for MPRI in the detection of a reduced CFR.
Thirty-five patients were evaluated (male-to-female ratio, 27:8; mean age +/- standard deviation, 63.5 years +/- 8.2; mean body mass index, 28.8 kg/m(2) +/- 3.8), and 43 vascular regions were analyzed. A linear correlation was found between the MPRI and CFR (r = 0.44, P < .05). The MPRI was significantly lower in vascular regions with a CFR of less than 2.00 than in regions with a CFR of 2.00 or greater (P < .05). Detection of a CFR of less than 2.00 was more accurate with subendocardial MPRI measurements than with transmural measurements. The mean subendocardial MPRI of the segments with the three lowest MPRIs of a vascular region showed the best diagnostic performance in the detection of a CFR of less than 2.00 (area under the ROC curve, 0.85; sensitivity, 84%; specificity, 75%) by using a cutoff value of 1.21.
The diagnostic accuracy of subendocardial perfusion analysis in contrast-enhanced cardiac MR imaging is higher than that of transmural analysis.
以前瞻性评估对比剂增强心脏磁共振（MR）成像通过将多普勒血流测量作为参考标准来确定受损冠状动脉血流储备（CFR）的准确性。
本研究经机构伦理委员会批准，所有患者均签署书面知情同意书。符合条件的患者接受了对比剂增强心脏MR成像和CFR的有创测量。对于对比剂增强MR成像，使用了具有稳态自由进动的三段单次激发饱和恢复梯度回波序列。层面分为六个节段。对于每个节段，通过使用静息时和静脉注射腺苷（每分钟每千克体重140微克）期间对比剂首次通过时信号强度-时间曲线的上升斜率来计算透壁和心内膜下心肌灌注储备指数（MPRI）。将血管区域的MPRI与相应的CFR进行比较。进行受试者操作特征（ROC）分析以确定MPRI最佳诊断准确性所需的节段数，并确定检测降低的CFR时MPRI的临界值。
评估了35例患者（男女比例为27∶8；平均年龄±标准差，63.5岁±8.2岁；平均体重指数，28.8 kg/m²±3.8），并分析了43个血管区域。发现MPRI与CFR之间存在线性相关性（r = 0.44，P <.05）。CFR小于2.00的血管区域的MPRI显著低于CFR为2.00或更高的区域（P <.05）。在心内膜下MPRI测量中检测CFR小于2.00比透壁测量更准确。血管区域中MPRI最低的三个节段的心内膜下MPRI平均值在检测CFR小于2.00时表现出最佳诊断性能（ROC曲线下面积，0.85；敏感性，84%；特异性，75%），临界值为1.21。
对比剂增强心脏MR成像中心内膜下灌注分析的诊断准确性高于透壁分析。
