Klein Christoph, Gebker Rolf, Kokocinski Thomas, Dreysse Stephan, Schnackenburg Bernhard, Fleck Eckart, Nagel Eike
German Heart Institute Berlin, Germany.
J Cardiovasc Magn Reson. 2008 Oct 17;10(1):45. doi: 10.1186/1532-429X-10-45.
Cardiovascular magnetic resonance (CMR) imaging offers methods for the detection of ischemia and myocardial infarction as well as visualization of the coronary arteries (MRCA). However, a direct comparison of adenosine perfusion (PERF), late gadolinium enhancement (LGE) and MRCA or the results of their combination has not been performed. Aim of the study was to evaluate the feasibility/diagnostic performance of rest/stress perfusion, late gadolinium enhancement and MRCA and their combination in patients with suspected coronary artery disease (CAD) in comparison to invasive angiography.
Fifty-four patients (60 +/- 10 years, 35 men, CAD 48%) underwent CMR including MRCA (steady state free precession, navigator whole heart approach, spatial resolution 0.7 x 0.7 x .0.9 mm, trigger delay and temporal resolution adjusted individually), stress PERF (adenosine 140 mug/min/kg), rest PERF (SSFP, 3 short axis, 1 saturation prepulse per slice) and LGE (3D inversion recovery technique) using Gd-BOPTA. Images were analyzed visually. Stenosis >50% in invasive angiography was considered significant.
Mean study time was 68 +/- 11 minutes. Sensitivity for PERF, LGE, MRCA and the combination of PERF/LGE and PERF/LGE/MRCA was 87%, 50%, 91%, 88% and 92%, respectively and specificity 88%, 96%, 46%, 88% and 56%, respectively. If image quality of MRCA was excellent (n = 18) the combination of MRCA/PERF/LGE yield a sensitivity of 86% and specificity of 91%. However, no test or combination improved diagnostic performance significantly compared to PERF alone.
In patients with CAD, the combination of stress PERF, LGE and MRCA is feasible. When compared to invasive angiography, adenosine stress perfusion outperforms CMR coronary angiography in direct comparison and yields the best results with non-significant improvement in combination with LGE and significant deterioration in combination with MRCA. MRCA may be of additional value only in a minority of patients with excellent image quality.
心血管磁共振（CMR）成像提供了检测心肌缺血和心肌梗死以及可视化冠状动脉（MRCA）的方法。然而，尚未对腺苷灌注（PERF）、钆延迟增强（LGE）和MRCA或它们联合使用的结果进行直接比较。本研究的目的是评估静息/负荷灌注、钆延迟增强和MRCA及其联合使用在疑似冠心病（CAD）患者中相对于有创血管造影的可行性/诊断性能。
54例患者（年龄60±10岁，男性35例，CAD患者占48%）接受了CMR检查，包括MRCA（稳态自由进动，导航全心脏成像方法，空间分辨率0.7×0.7×0.9mm，触发延迟和时间分辨率单独调整）、负荷PERF（腺苷140μg/min/kg）、静息PERF（稳态自由进动序列，3个短轴层面，每层1个饱和预脉冲）以及使用钆布醇的LGE（三维反转恢复技术）。图像由肉眼分析。有创血管造影中狭窄>50%被视为有意义。
平均研究时间为68±11分钟。PERF、LGE、MRCA以及PERF/LGE和PERF/LGE/MRCA联合使用的敏感性分别为87%、50%、91%、88%和92%，特异性分别为88%、96%、46%、88%和56%。如果MRCA的图像质量极佳（n = 18），MRCA/PERF/LGE联合使用的敏感性为86%，特异性为91%。然而，与单独的PERF相比，没有任何一种检查或联合检查能显著提高诊断性能。
在CAD患者中，负荷PERF、LGE和MRCA联合使用是可行的。与有创血管造影相比，腺苷负荷灌注在直接比较中优于CMR冠状动脉造影，单独使用时效果最佳，与LGE联合使用时无显著改善，与MRCA联合使用时显著恶化。MRCA可能仅在少数图像质量极佳的患者中具有额外价值。
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