Futamatsu Hideki, Klassen Chris, Pilla Marco, Wilke Norbert, Angiolillo Dominick J, Smalheiser Stuart, Siuciak Alan, Suzuki Nobuaki, Bass Theodore A, Costa Marco A
Division of Cardiology and Cardiovascular Imaging Core Laboratories, University of Florida, 655 West 8th Street, Jacksonville, FL 32209, USA.
Int J Cardiovasc Imaging. 2008 Mar;24(3):293-9. doi: 10.1007/s10554-007-9263-3. Epub 2007 Sep 11.
Cardiac MRI (cMRI) perfusion is a promising non-invasive tool to assess myocardial ischemia. The accuracy of quantitative cMRI perfusion has been recently demonstrated, but to date no previous study has compared this technique with stress single-photon-emission computed tomography (SPECT). The aim of this study was to evaluate the diagnostic accuracy of myocardial perfusion reserve (MPR) based on cMRI compared with SPECT.
We examined 24 patients who underwent coronary angiography, stress SPECT and cMRI perfusion. Qualitative assessment of both SPECT and cMRI images, quantification of cMRI perfusion, and quantitative coronary angiography (QCA) were independently performed. MPR was calculated using Fermi deconvolution technique. Accuracy of quantitative and qualitative data was examined to detect > 50% diameter stenosis (DS) by QCA.
Qualitative analysis was obtained in 198 segments and quantitative analysis was performed in 171 segments. Significant coronary artery disease (CAD) was present in 81.8% of patients. Visual cMRI assessment yielded sensitivity of 74.4% and specificity of 79.4% to predict > 50%DS, while SPECT showed sensitivity of 67.4% and specificity of 81.3%. The sensitivity for SPECT in the right coronary artery territory and apex was low compared to cMRI. Sensitivity and specificity for detection of significant CAD were 89.5% and 46.6% for MPR (cutoff 1.92). Area under the curve was 0.75 for MPR (P < 0.01).
The diagnostic accuracy of qualitative examination of perfusion cardiac MRI and stress SPECT were comparable. The high sensitivity and low operator dependency of quantitative cMRI makes it an attractive tool to evaluate myocardial perfusion.
心脏磁共振成像（cMRI）灌注是一种很有前景的评估心肌缺血的非侵入性工具。近期已证实定量cMRI灌注的准确性，但迄今为止尚无研究将该技术与负荷单光子发射计算机断层扫描（SPECT）进行比较。本研究旨在评估基于cMRI的心肌灌注储备（MPR）与SPECT相比的诊断准确性。
我们检查了24例接受冠状动脉造影、负荷SPECT和cMRI灌注的患者。独立进行SPECT和cMRI图像的定性评估、cMRI灌注定量以及定量冠状动脉造影（QCA）。使用费米反卷积技术计算MPR。通过QCA检查定量和定性数据检测直径狭窄（DS）>50%的准确性。
对198个节段进行了定性分析，对171个节段进行了定量分析。81.8%的患者存在显著冠状动脉疾病（CAD）。cMRI视觉评估预测DS>50%的敏感性为74.4%，特异性为79.4%，而SPECT的敏感性为67.4%，特异性为81.3%。与cMRI相比，SPECT在右冠状动脉区域和心尖的敏感性较低。MPR检测显著CAD的敏感性和特异性分别为89.5%和46.6%（临界值1.92）。MPR的曲线下面积为0.75（P<0.01）。
灌注心脏MRI定性检查和负荷SPECT的诊断准确性相当。定量cMRI的高敏感性和低操作者依赖性使其成为评估心肌灌注的有吸引力的工具。
