Department of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany.
JACC Cardiovasc Imaging. 2010 Apr;3(4):375-84. doi: 10.1016/j.jcmg.2009.12.008.
This study determined the value of navigator-gated 3-dimensional blood oxygen level-dependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions.
Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies.
Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction > or =50%). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [DeltaSI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]).
The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90% and 84% of the patients, respectively. The DeltaSI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p < 0.001). The receiver-operator characteristic analysis identified a cutoff value of DeltaSI = 2.7% for the detection of coronary stenosis, resulting in a sensitivity and specificity of 85.0% and 80.5%, respectively. An MPRI cutoff value of 1.35 yielded a sensitivity and specificity of 89.5% and 85.8%, respectively. The DeltaSI significantly correlated with the degree of coronary stenosis (r = -0.65, p < 0.001). Additionally, DeltaSI and MPRI showed substantial agreement (kappa value 0.66).
Navigator-gated 3-dimensional BOLD imaging at 3.0-T reliably detected stress-induced myocardial ischemic reactions and may be considered a valid alternative to first-pass exogenous contrast-enhancement studies.
本研究旨在探讨在 3.0T 场强下导航门控三维血氧水平依赖（BOLD）心脏磁共振（CMR）在检测应激诱导心肌缺血反应中的应用价值。
尽管 BOLD CMR 已被用于心肌氧合状态的特征描述，但以前报道的 CMR 方法由于信噪比低且存在运动伪影，导致图像质量受损，在最初的患者研究中诊断价值有限。
50 例疑似或已知冠状动脉疾病的患者在 3.0T 下进行 CMR 检查，随后在 48 小时内行有创 X 射线血管造影检查。在自由呼吸下采用全左心室短轴覆盖方式采集三维 BOLD 图像。BOLD 成像在静息和腺苷负荷状态下进行，随后进行负荷和静息首过灌注及延迟增强成像。定量冠状动脉 X 射线血管造影（QCA）用于冠状动脉狭窄的定义（直径减少≥50%）。BOLD 和首过灌注图像进行半定量评估（BOLD 成像时，评估应激和静息状态下的信号强度差异[DeltaSI]；首过灌注成像时，评估心肌灌注储备指数[MPRI]）。
BOLD CMR 在静息和腺苷负荷状态下的图像质量分别在 90%和 84%的患者中被评为良好至优秀。DeltaSI 测量值在正常心肌、狭窄冠状动脉供血区心肌和梗死心肌之间存在显著差异（p<0.001）。受试者工作特征曲线分析确定 DeltaSI=2.7%作为检测冠状动脉狭窄的截断值，其灵敏度和特异度分别为 85.0%和 80.5%。MPRI 的截断值为 1.35，其灵敏度和特异度分别为 89.5%和 85.8%。DeltaSI 与冠状动脉狭窄程度显著相关（r=-0.65，p<0.001）。此外，DeltaSI 和 MPRI 之间具有高度一致性（kappa 值为 0.66）。
3.0T 场强下导航门控三维 BOLD 成像可可靠地检测应激诱导的心肌缺血反应，可作为首过外源性对比增强研究的有效替代方法。
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