Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
J Magn Reson Imaging. 2021 Mar;53(3):777-788. doi: 10.1002/jmri.27396. Epub 2020 Oct 16.
Myocardial perfusion is evaluated in first-pass MRI using a gadolinium-based contrast agent, which limits its repeatability and restricts its use in patients with abnormal kidney function. Arterial spin labeling (ASL) is a promising technique for measuring myocardial perfusion without contrast injection. The ratio of stress to rest perfusion, termed myocardial perfusion reserve (MPR), is an indicator of the severity of stenosis in patients with coronary artery disease (CAD).
To quantify perfusion increases with pharmacological vasodilation, explore MPR differences between segments with and without perfusion defects, and examine the correlations between quantitative ASL and semiquantitative first-pass measurements.
Prospective.
Sixteen patients with suspected CAD: 10 classified as "healthy," having normal perfusion on first-pass and no enhancement on late gadolinium enhancement (LGE), and six as "nonhealthy," having hypoperfused segments including ischemic and infarcted.
FIELD STRENGTH/SEQUENCE: Flow-sensitive alternating inversion recovery (FAIR) rest-stress cardiac ASL with balanced steady-state free precession (bSSFP), rest-stress first-pass imaging using gradient-echo and LGE using a phase-sensitive inversion-recovery bSSFP at 1.5T.
For healthy subjects, rest-stress perfusion data were compared in global, coronary artery territory, and segment regions of interest (ROIs). A segmental MPR comparison was performed between normal segments from healthy subjects and abnormal segments from nonhealthy subjects. Correlations between ASL and first-pass parameters were explored.
Wilcoxon-signed-rank test, nonparametric factorial analysis of variance (ANOVA), and Pearson's/Spearman's correlations.
Perfusion increases were significant globally (P = 0.005), per coronary artery territory (P = 0.015), and per segment (P = 0.03 for all segments in ASL and first-pass, except anteroseptal in ASL P = 0.04). MPR differences between normal and abnormal segments were significant (P = 0.0028: ASL, P = 0.033: first-pass). ASL and first-pass measurements were correlated (MPR: r = 0.64, P = 0.008 and perfusion: rho = 0.47, P = 0.007).
This study demonstrates the feasibility of ASL to detect hyperemia, the potential to differentiate segments with and without perfusion defects, and significant correlations between ASL and semiquantitative first-pass.
2 TECHNICAL EFFICACY STAGE: 1.
心肌灌注是通过使用钆基造影剂的首过 MRI 进行评估的，这限制了其可重复性，并限制了其在肾功能异常的患者中的使用。动脉自旋标记（ASL）是一种测量心肌灌注而无需注射造影剂的有前途的技术。称为心肌灌注储备（MPR）的应激与休息灌注比是评估冠状动脉疾病（CAD）患者狭窄严重程度的指标。
量化药物诱发的灌注增加，探讨有灌注缺陷和无灌注缺陷节段之间的 MPR 差异，并检查定量 ASL 与半定量首过测量之间的相关性。
前瞻性。
16 例疑似 CAD 患者：10 例为“健康”，首过和晚期钆增强（LGE）均无灌注增强，6 例为“非健康”，存在包括缺血和梗死的灌注不足节段。
磁场强度/序列：使用平衡稳态自由进动（bSSFP）的流量敏感交替反转恢复（FAIR）静息-应激心脏 ASL、使用梯度回波的静息-应激首过成像和使用相位敏感反转恢复 bSSFP 的 LGE，均在 1.5T 下进行。
对于健康受试者，比较了全局、冠状动脉区域和节段感兴趣区域（ROI）的静息-应激灌注数据。在健康受试者的正常节段和非健康受试者的异常节段之间进行了节段性 MPR 比较。探索了 ASL 和首过参数之间的相关性。
Wilcoxon 符号秩检验、非参数因子方差分析（ANOVA）和 Pearson/Spearman 相关性。
全局（P = 0.005）、每支冠状动脉区域（P = 0.015）和每节段（ASL 中的所有节段除外前间隔，P = 0.04，首过 P = 0.03）的灌注增加均有统计学意义。正常和异常节段之间的 MPR 差异具有统计学意义（ASL：P = 0.0028，第一遍：P = 0.033）。ASL 和首过测量结果相关（MPR：r = 0.64，P = 0.008，灌注：rho = 0.47，P = 0.007）。
本研究证明了 ASL 检测充血的可行性、区分有灌注缺陷和无灌注缺陷节段的潜力，以及 ASL 和半定量首过之间的显著相关性。
2 技术功效阶段：1。
