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Coronary Artery Disease: Myocardial Perfusion MR Imaging with Sensitivity Encoding versus Conventional Angiography¹

¹ From the BHF Cardiac Magnetic Resonance Unit (S.P., D.B., J.P.G., M.U.S.) and Department of Medical Physics (A.R., J.P.R.), the General Infirmary at Leeds, Room 170, D-floor, Jubilee Bldg, Great George St, Leeds LS1 3EX, England; and Institute of Cardiovascular Research, University of Leeds, Leeds, England (S.G.B.). Received March 9, 2004; revision requested May 20; revision received June 24; accepted July 27. S.P. supported by British Heart Foundation. Address correspondence to S.P. (e-mail: sven.plein@leedsth.nhs.uk).

View larger version (26K): [in a new window]   Figure 1. Segmentation of left ventricular myocardium. Numbers 1-16 indicate segment numbers. CX = circumflex coronary artery, LAD = left anterior descending coronary artery, RCA = right coronary artery. Three short-axis section levels were analyzed: the apical, midventricular (Mid), and basal levels.

View larger version (29K): [in a new window]   Figure 2. Graphs illustrate the baseline signal intensity (top), signal intensity amplitude (middle), and MPRI (bottom) (all in arbitrary units [aU]) of the 16 segments in the 10 volunteers. X-axis denotes segment numbers, based on the designations illustrated in Figure 1, with segments 1-6 located in the basal section, segments 7-12 located in the midventricular section, and segments 13-16 located in the apical section. Y-axis denotes values for baseline signal intensity, maximal signal intensity amplitude, and MPRI of signal intensity profiles. The baseline signal intensity was similar for segments on the same section but increased progressively from the basal to the apical section. The amplitude of myocardial enhancement was similar for segments on the same section but lower overall on sections 2 and 3. The 16 segments had similar MPRIs, and differences between the three sections were small.

View larger version (34K): [in a new window]   Figure 3. Signal intensity-time curves for the aortic input function and the myocardium in three randomly chosen volunteers. The signal intensity profiles in these subjects show a sharp upslope, with no apparent saturation effects.

View larger version (25K): [in a new window]   Figure 4. ROC curves for analysis of all sections combined (left) and for separate analyses of individual sections (right). The area under the ROC curve for the analysis of the three sections combined was 0.908. Individual analyses of each section yielded areas under the ROC curve of 0.807 for section 1, 0.864 for section 2, and 0.798 for section 3; differences in diagnostic performance among the individual analyses were not significant.

View larger version (161K): [in a new window]   Figure 5a. (a, b) Cardiac MR (CMR) images acquired in left ventricular short-axis orientation with a saturation-recovery T1-weighted turbo field-echo pulse sequence accelerated with SENSE (3.3/1.6, 15° flip angle, SENSE factor of two) and (c) corresponding conventional angiogram. Midventricular cardiac MR image acquired at rest (a) and corresponding midventricular cardiac MR image acquired during stress (b). The stress image shows an inducible full-thickness perfusion defect (arrow) in segment 11 of the left circumflex coronary artery territory. The MPRI of the subendocardial half of the segment is 0.861. (c) Corresponding angiogram shows a stenotic lesion (arrow) in the middle segment of the left circumflex coronary artery.

View larger version (159K): [in a new window]   Figure 5b. (a, b) Cardiac MR (CMR) images acquired in left ventricular short-axis orientation with a saturation-recovery T1-weighted turbo field-echo pulse sequence accelerated with SENSE (3.3/1.6, 15° flip angle, SENSE factor of two) and (c) corresponding conventional angiogram. Midventricular cardiac MR image acquired at rest (a) and corresponding midventricular cardiac MR image acquired during stress (b). The stress image shows an inducible full-thickness perfusion defect (arrow) in segment 11 of the left circumflex coronary artery territory. The MPRI of the subendocardial half of the segment is 0.861. (c) Corresponding angiogram shows a stenotic lesion (arrow) in the middle segment of the left circumflex coronary artery.

View larger version (149K): [in a new window]   Figure 5c. (a, b) Cardiac MR (CMR) images acquired in left ventricular short-axis orientation with a saturation-recovery T1-weighted turbo field-echo pulse sequence accelerated with SENSE (3.3/1.6, 15° flip angle, SENSE factor of two) and (c) corresponding conventional angiogram. Midventricular cardiac MR image acquired at rest (a) and corresponding midventricular cardiac MR image acquired during stress (b). The stress image shows an inducible full-thickness perfusion defect (arrow) in segment 11 of the left circumflex coronary artery territory. The MPRI of the subendocardial half of the segment is 0.861. (c) Corresponding angiogram shows a stenotic lesion (arrow) in the middle segment of the left circumflex coronary artery.