From the University and ETH Zurich, Zurich, Switzerland (R.M., L.W., S.K.); University Heart Center, University Hospital Zurich, Zurich, Switzerland (R.M., M.N., A.G., T.F.L.); German Heart Institute, Berlin, Germany (R.G., B.S., E.F.); King's College London, London, United Kingdom (R.J., E.N.); University of Leeds, Leeds, United Kingdom (M.M., S.P.); and University Hospital RWTH Aachen, Germany (M.F., S.R., C.K., N.M.).
Circ Cardiovasc Imaging. 2015 May;8(5). doi: 10.1161/CIRCIMAGING.114.003061.
First-pass myocardial perfusion cardiovascular magnetic resonance (CMR) imaging yields high diagnostic accuracy for the detection of coronary artery disease (CAD). However, standard 2D multislice CMR perfusion techniques provide only limited cardiac coverage, and hence considerable assumptions are required to assess myocardial ischemic burden. The aim of this prospective study was to assess the diagnostic performance of 3D myocardial perfusion CMR to detect functionally relevant CAD with fractional flow reserve (FFR) as a reference standard in a multicenter setting.
A total of 155 patients with suspected CAD listed for coronary angiography with FFR were prospectively enrolled from 5 European centers. 3D perfusion CMR was acquired on 3T MR systems from a single vendor under adenosine stress and at rest. All CMR perfusion analyses were performed in a central laboratory and blinded to all clinical data. One hundred fifty patients were successfully examined (mean age 62.9±10 years, 45 female). The prevalence of CAD defined by FFR (<0.8) was 56.7% (85 of 150 patients). The sensitivity and specificity of 3D perfusion CMR were 84.7% and 90.8% relative to the FFR reference. Comparison to quantitative coronary angiography (≥50%) yielded a prevalence of 65.3%, sensitivity and specificity of 76.5% and 94.2%, respectively.
In this multicenter study, 3D myocardial perfusion CMR proved highly diagnostic for the detection of significant CAD as defined by FFR.
首次通过心肌灌注心血管磁共振（CMR）成像在检测冠状动脉疾病（CAD）方面具有较高的诊断准确性。然而，标准的 2D 多层 CMR 灌注技术仅提供有限的心脏覆盖范围，因此需要进行大量假设来评估心肌缺血负担。本前瞻性研究的目的是评估 3D 心肌灌注 CMR 在多中心环境中以血流储备分数（FFR）作为参考标准检测功能相关 CAD 的诊断性能。
共前瞻性纳入了来自欧洲 5 个中心的 155 例疑似 CAD 并拟行冠状动脉造影术伴 FFR 的患者。在腺苷应激和静息状态下，使用来自单一供应商的 3T MR 系统采集 3D 灌注 CMR。所有 CMR 灌注分析均在中心实验室进行，且与所有临床数据均为盲法。150 例患者成功接受了检查（平均年龄 62.9±10 岁，女性 45 例）。FFR 定义的 CAD 患病率为 56.7%（150 例患者中有 85 例）。与 FFR 参考标准相比，3D 灌注 CMR 的敏感性和特异性分别为 84.7%和 90.8%。与定量冠状动脉造影术（≥50%）相比，患病率为 65.3%，敏感性和特异性分别为 76.5%和 94.2%。
在这项多中心研究中，3D 心肌灌注 CMR 对 FFR 定义的显著 CAD 检测具有高度的诊断价值。
