Michael Salerno1, Angela Taylor2, Yang Yang2, Sujith Kuruvilla2, Michael Ragosta2, Craig H Meyer2, Christopher M Kramer2. 1. From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.). msalerno@virginia.edu. 2. From the Cardiovascular Division, Department of Medicine (M.S., A.T., S.K., M.R., C.M.K.) and Department of Radiology and Medical Imaging (M.S., C.H.M., C.M.K.), University of Virginia Health System, Charlottesville; and Department of Biomedical Engineering, University of Virginia, Charlottesville (M.S., Y.Y., C.H.M.).
Abstract
BACKGROUND: Adenosine stress cardiovascular magnetic resonance perfusion imaging can be limited by motion-induced dark-rim artifacts, which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral pulse sequence with a novel density compensation strategy has been shown to reduce dark-rim artifacts in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress cardiovascular magnetic resonance using this new perfusion sequence to detect obstructive coronary artery disease. METHODS AND RESULTS: Cardiovascular magnetic resonance perfusion imaging was performed during adenosine stress (140 μg/kg per minute) and at rest on a Siemens 1.5-T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography. Perfusion images were acquired during injection of 0.1 mmol/kg Gadolinium-diethylenetriaminepentacetate at 3 short-axis locations using a saturation recovery interleaved variable-density spiral pulse sequence. Significant stenosis was defined as >50% by quantitative coronary angiography. Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5-point scale (1 [poor] to 5 [excellent]). The prevalence of obstructive coronary artery disease by quantitative coronary angiography was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88%, respectively, with a positive predictive value and negative predictive value of 93% and 79%, respectively. The average image quality score was 4.4±0.7, with only 1 study with more than mild dark-rim artifacts. There was good inter-reader reliability with a κ statistic of 0.67. CONCLUSIONS: Spiral adenosine stress cardiovascular magnetic resonance results in high diagnostic accuracy for the detection of obstructive coronary artery disease with excellent image quality and minimal dark-rim artifacts.
BACKGROUND: Adenosine stress cardiovascular magnetic resonance perfusion imaging can be limited by motion-induced dark-rim artifacts, which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral pulse sequence with a novel density compensation strategy has been shown to reduce dark-rim artifacts in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress cardiovascular magnetic resonance using this new perfusion sequence to detect obstructive coronary artery disease. METHODS AND RESULTS: Cardiovascular magnetic resonance perfusion imaging was performed during adenosine stress (140 μg/kg per minute) and at rest on a Siemens 1.5-T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography. Perfusion images were acquired during injection of 0.1 mmol/kg Gadolinium-diethylenetriaminepentacetate at 3 short-axis locations using a saturation recovery interleaved variable-density spiral pulse sequence. Significant stenosis was defined as >50% by quantitative coronary angiography. Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5-point scale (1 [poor] to 5 [excellent]). The prevalence of obstructive coronary artery disease by quantitative coronary angiography was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88%, respectively, with a positive predictive value and negative predictive value of 93% and 79%, respectively. The average image quality score was 4.4±0.7, with only 1 study with more than mild dark-rim artifacts. There was good inter-reader reliability with a κ statistic of 0.67. CONCLUSIONS: Spiral adenosine stress cardiovascular magnetic resonance results in high diagnostic accuracy for the detection of obstructive coronary artery disease with excellent image quality and minimal dark-rim artifacts.
Authors: Igor Klem; John F Heitner; Dipan J Shah; Michael H Sketch; Victor Behar; Jonathan Weinsaft; Peter Cawley; Michele Parker; Michael Elliott; Robert M Judd; Raymond J Kim Journal: J Am Coll Cardiol Date: 2006-03-27 Impact factor: 24.094
Authors: Sven Plein; Salome Ryf; Juerg Schwitter; Aleksandra Radjenovic; Peter Boesiger; Sebastian Kozerke Journal: Magn Reson Med Date: 2007-10 Impact factor: 4.668
Authors: Taehoon Shin; Krishna S Nayak; Juan M Santos; Dwight G Nishimura; Bob S Hu; Michael V McConnell Journal: Magn Reson Med Date: 2012-05-03 Impact factor: 4.668
Authors: Christopher M Kramer; Jörg Barkhausen; Scott D Flamm; Raymond J Kim; Eike Nagel Journal: J Cardiovasc Magn Reson Date: 2013-10-08 Impact factor: 5.364
Authors: Yang Yang; Craig H Meyer; Frederick H Epstein; Christopher M Kramer; Michael Salerno Journal: Magn Reson Med Date: 2018-10-12 Impact factor: 4.668
Authors: Yang Yang; Li Zhao; Xiao Chen; Peter W Shaw; Jorge A Gonzalez; Frederick H Epstein; Craig H Meyer; Christopher M Kramer; Michael Salerno Journal: Magn Reson Med Date: 2017-03-20 Impact factor: 4.668
Authors: Allison D Ta; Li-Yueh Hsu; Hannah M Conn; Susanne Winkler; Anders M Greve; Sujata M Shanbhag; Marcus Y Chen; W Patricia Bandettini; Andrew E Arai Journal: J Cardiovasc Magn Reson Date: 2018-03-08 Impact factor: 5.364
Authors: Ruixi Zhou; Wei Huang; Yang Yang; Xiao Chen; Daniel S Weller; Christopher M Kramer; Sebastian Kozerke; Michael Salerno Journal: J Cardiovasc Magn Reson Date: 2018-02-01 Impact factor: 5.364
Authors: Benjamin Zorach; Peter W Shaw; Jamieson Bourque; Sujith Kuruvilla; Pelbreton C Balfour; Yang Yang; Roshin Mathew; Jonathan Pan; Jorge A Gonzalez; Angela M Taylor; Craig H Meyer; Frederick H Epstein; Christopher M Kramer; Michael Salerno Journal: J Cardiovasc Magn Reson Date: 2018-02-22 Impact factor: 5.364