Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
Eur Heart J. 2012 Aug;33(16):2016-24. doi: 10.1093/eurheartj/ehs170. Epub 2012 Jun 7.
Dynamic three-dimensional-cardiac magnetic resonance (3D-CMR) perfusion proved highly diagnostic for the detection of angiographically defined coronary artery disease (CAD) and has been used to assess the efficacy of coronary stenting procedures. The present study aimed to relate significant coronary lesions as assessed by fractional flow reserve (FFR) to the volume of myocardial hypoenhancement on 3D-CMR adenosine stress perfusion imaging and to define the inter-study reproducibility of stress inducible 3D-CMR hypoperfusion.
A total of 120 patients with known or suspected CAD were examined in two CMR centres using 1.5 T systems. The protocol included cine imaging, 3D-CMR perfusion during adenosine infusion, and at rest followed by delayed enhancement (DE) imaging. Fractional flow reserve was recorded in epicardial coronary arteries and side branches with ≥2 mm luminal diameter and >40% severity stenosis (pathologic FFR < 0.75). Twenty-five patients underwent an identical repeat CMR examination for the determination of inter-study reproducibility of 3D-CMR perfusion deficits induced by adenosine. Three-dimensional CMR perfusion scans were visually classified as pathologic if one or more segments showed an inducible perfusion deficit in the absence of DE. Myocardial ischaemic burden (MIB) was measured by segmentation of the area of inducible hypoenhancement and normalized to left ventricular myocardial volume (MIB, %). Three-dimensional CMR perfusion resulted in a sensitivity, specificity, and diagnostic accuracy of 90, 82, and 87%, respectively. Substantial concordance was found for inter-study reproducibility [Lin's correlation coefficient: 0.98 (95% confidence interval: 0.96-0.99)].
Three-dimensional CMR stress perfusion provided high diagnostic accuracy for the detection of functionally significant CAD. Myocardial ischaemic burden measurements were highly reproducible and allowed the assessment of CAD severity.
动态三维心脏磁共振（3D-CMR）灌注在检测血管造影定义的冠状动脉疾病（CAD）方面具有高度的诊断价值，并已用于评估冠状动脉支架置入术的疗效。本研究旨在将通过血流储备分数（FFR）评估的有意义的冠状动脉病变与 3D-CMR 腺苷应激灌注成像上的心肌低增强容积相关联，并定义应激诱导的 3D-CMR 灌注不足的研究间可重复性。
共有 120 名已知或疑似 CAD 的患者在两个 1.5 T 系统的 CMR 中心接受检查。该方案包括电影成像、腺苷输注时的 3D-CMR 灌注以及随后的延迟增强（DE）成像。在 >40%狭窄（病理性 FFR < 0.75）的 ≥2 mm 管腔直径的心外膜冠状动脉和侧支中记录了血流储备分数。25 例患者接受了相同的重复 CMR 检查，以确定腺苷诱导的 3D-CMR 灌注不足的研究间可重复性。如果在没有 DE 的情况下一个或多个节段显示可诱导的灌注不足，则将 3D-CMR 灌注扫描视觉上分类为病理性。通过分割可诱导低增强的区域来测量心肌缺血负荷（MIB），并将其归一化为左心室心肌容积（MIB，%）。3D-CMR 灌注的敏感性、特异性和诊断准确性分别为 90%、82%和 87%。研究间可重复性的一致性很高[Lin 的相关系数：0.98（95%置信区间：0.96-0.99）]。
3D-CMR 应激灌注对检测有功能意义的 CAD 具有较高的诊断准确性。心肌缺血负荷测量具有高度的可重复性，并且允许评估 CAD 的严重程度。
