|
1
|
Choe YH, Kim SM. Recent Progress of Cardiac MRI for Nuclear Medicine Professionals. Nucl Med Mol Imaging 2024; 58:431-448. [PMID: 39635630 PMCID: PMC11612075 DOI: 10.1007/s13139-024-00850-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 12/07/2024] Open
Abstract
Recent technical innovation enables faster and more reliable cardiac magnetic resonance (CMR) imaging than before. Artificial intelligence is used in improving image resolution, fast scanning, and automated analysis of CMR. Fast CMR techniques such as compressed sensing technique enable fast cine, perfusion, and late gadolinium-enhanced imaging and improve patient throughput and widening CMR indications. CMR feature-tracking technique gives insight on diastolic function parameters of ventricles and atria with prognostic implications. Myocardial parametric mapping became to be included in the routine CMR protocol. CMR fingerprinting enables simultaneous quantification of myocardial T1 and T2. These parameters may give information on myocardial alteration in the preclinical stages in various myocardial diseases. Four-dimensional flow imaging shows hemodynamic characteristics in or through the cardiovascular structures visually and gives quantitative values of vortex, kinetic energy, and wall-shear stress. In conclusion, CMR is an essential modality in the diagnosis of various cardiovascular diseases, especially myocardial diseases. Recent progress in CMR techniques promotes more widespread use of CMR in clinical practice. This review summarizes recent updates in CMR technologies and clinical research.
Collapse
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology and Center for Imaging Science, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnam-Gu, Seoul, 06351 South Korea
| | - Sung Mok Kim
- Department of Radiology and Center for Imaging Science, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnam-Gu, Seoul, 06351 South Korea
| |
Collapse
|
|
2
|
Li XM, Jiang L, Min CY, Yan WF, Shen MT, Liu XJ, Guo YK, Yang ZG. Myocardial Perfusion Imaging by Cardiovascular Magnetic Resonance: Research Progress and Current Implementation. Curr Probl Cardiol 2023; 48:101665. [PMID: 36828047 DOI: 10.1016/j.cpcardiol.2023.101665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Cardiovascular diseases pose a significant health and economic burden worldwide, with coronary artery disease still recognized as a major problem. It is closely associated with hypertension, diabetes, obesity, smoking, lack of exercise, poor diet, and excessive alcohol consumption, which may lead to macro- and microvascular abnormalities in the heart. Coronary artery stenosis reduces the local supply of oxygen and nutrients to the myocardium and results in reduced levels of myocardial perfusion, which can lead to more severe conditions and irreversible damage to myocardial tissues. Therefore, accurate evaluation of myocardial perfusion abnormalities in patients with these risk factors is critical. As technology advances, magnetic resonance myocardial perfusion imaging has become more accurate at evaluating the myocardial microcirculation and has shown a powerful ability to detect myocardial ischemia. The purpose of this review is to summarize the principle, research progress of acquisition and analysis, and clinical implementation of cardiovascular magnetic resonance (CMR) myocardial perfusion imaging.
Collapse
Affiliation(s)
- Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Jing Liu
- Laboratory of Cardiovascular Diseases, Regenerative Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
|
3
|
Hamzaraj K, Kammerlander A, Gyöngyösi M, Frey B, Distelmaier K, Graf S. Patient Selection and Clinical Indication for Chronic Total Occlusion Revascularization-A Workflow Focusing on Non-Invasive Cardiac Imaging. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010004. [PMID: 36675954 PMCID: PMC9864679 DOI: 10.3390/life13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Percutaneous coronary intervention of chronic total occlusion (CTO PCI) is a challenging procedure with high complication rates and, as not yet fully understood long-term clinical benefits. Ischemic symptom relief in patients with high ischemic burden is to date the only established clinical indication to undergo CTO PCI, supported by randomized controlled trials. In this context, current guidelines suggest attempting CTO PCI only in non-invasively assessed viable CTO correspondent myocardial territories, with large ischemic areas. Hence, besides a comprehensive coronary angiography lesion evaluation, the information derived from non-invasive cardiac imaging techniques is crucial to selecting candidates who may benefit from the revascularization of the occluded vessel. Currently, there are no clear recommendations for a non-invasive myocardial evaluation or choice of imaging modality pre-CTO PCI. Therefore, selecting among available options is left to the physician's discretion. As CTO PCI is strongly recommended to be carried out explicitly in experienced centers, full access to non-invasive imaging for risk-benefit assessment as well as a systematic institutional evaluation process has to be encouraged. In this framework, we opted to review the current myocardial imaging tools and their use for indicating a CTO PCI. Furthermore, based on our experience, we propose a cost-effective systematic approach for myocardial assessment to help guide clinical decision-making for patients presenting with chronic total occlusions.
Collapse
|
|
4
|
Sanguineti F, Duhamel S, Garot P, Garot J. [The role of Cardiovascular Magnetic Resonance in Interventional Cardiology]. Ann Cardiol Angeiol (Paris) 2022; 71:362-367. [PMID: 36229237 DOI: 10.1016/j.ancard.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cardiovascular magnetic resonance has emerged as a very helpful tool for the interventional cardiologists not only in the assessment and treatment of coronary artery disease, but also in the evaluation of various structural cardiac diseases. The main pulse sequences are standardised, acquired during short breath-holds, and include steady-state free precession cines, dynamic myocardial first-pass perfusion imaging during contrast injection, and late enhancement imaging for the identification of myocardial substrates. Less than 30-minute CMR studies are now available for the most common clinical indications. More recently, T1 and T2 parametric myocardial maps are promising for detailed myocardial tissue characterisation (edema, replacement fibrosis, diffuse interstitial fibrosis). Technical aspects will not be addressed with particular emphasis on clinical applications.
Collapse
Affiliation(s)
- Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Suzanne Duhamel
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France; Institut Cardiovasculaire Paris Sud, Cardiologie Interventionnelle, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300, Massy, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, IRM Cardiovasculaire, Hôpital Privé Jacques CARTIER, Ramsay Santé, 6 Avenue du Noyer Lambert, 91300, Massy, France.
| |
Collapse
|
|
5
|
Hoh T, Vishnevskiy V, Polacin M, Manka R, Fuetterer M, Kozerke S. Free-breathing motion-informed locally low-rank quantitative 3D myocardial perfusion imaging. Magn Reson Med 2022; 88:1575-1591. [PMID: 35713206 PMCID: PMC9544898 DOI: 10.1002/mrm.29295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/30/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To propose respiratory motion-informed locally low-rank reconstruction (MI-LLR) for robust free-breathing single-bolus quantitative 3D myocardial perfusion CMR imaging. Simulation and in-vivo results are compared to locally low-rank (LLR) and compressed sensing reconstructions (CS) for reference. METHODS Data were acquired using a 3D Cartesian pseudo-spiral in-out k-t undersampling scheme (R = 10) and reconstructed using MI-LLR, which encompasses two stages. In the first stage, approximate displacement fields are derived from an initial LLR reconstruction to feed a motion-compensated reference system to a second reconstruction stage, which reduces the rank of the inverse problem. For comparison, data were also reconstructed with LLR and frame-by-frame CS using wavelets as sparsifying transform ( ℓ 1 $$ {\ell}_1 $$ -wavelet). Reconstruction accuracy relative to ground truth was assessed using synthetic data for realistic ranges of breathing motion, heart rates, and SNRs. In-vivo experiments were conducted in healthy subjects at rest and during adenosine stress. Myocardial blood flow (MBF) maps were derived using a Fermi model. RESULTS Improved uniformity of MBF maps with reduced local variations was achieved with MI-LLR. For rest and stress, intra-volunteer variation of absolute and relative MBF was lower in MI-LLR (±0.17 mL/g/min [26%] and ±1.07 mL/g/min [33%]) versus LLR (±0.19 mL/g/min [28%] and ±1.22 mL/g/min [36%]) and versus ℓ 1 $$ {\ell}_1 $$ -wavelet (±1.17 mL/g/min [113%] and ±6.87 mL/g/min [115%]). At rest, intra-subject MBF variation was reduced significantly with MI-LLR. CONCLUSION The combination of pseudo-spiral Cartesian undersampling and dual-stage MI-LLR reconstruction improves free-breathing quantitative 3D myocardial perfusion CMR imaging under rest and stress condition.
Collapse
Affiliation(s)
- Tobias Hoh
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Valery Vishnevskiy
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| | - Malgorzata Polacin
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Robert Manka
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
- Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
- Department of CardiologyUniversity Heart Center, University Hospital Zurich, University of ZurichZurichSwitzerland
| | | | - Sebastian Kozerke
- Institute for Biomedical EngineeringUniversity and ETH ZurichZurichSwitzerland
| |
Collapse
|
|
6
|
Nazir MS, Shome J, Villa ADM, Ryan M, Kassam Z, Razavi R, Kozerke S, Ismail TF, Perera D, Chiribiri A, Plein S. 2D high resolution vs. 3D whole heart myocardial perfusion cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2022; 23:811-819. [PMID: 34179941 PMCID: PMC9159745 DOI: 10.1093/ehjci/jeab103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
AIMS Developments in myocardial perfusion cardiovascular magnetic resonance (CMR) allow improvements in spatial resolution and/or myocardial coverage. Whole heart coverage may provide the most accurate assessment of myocardial ischaemic burden, while high spatial resolution is expected to improve detection of subendocardial ischaemia. The objective of this study was to compare myocardial ischaemic burden as depicted by 2D high resolution and 3D whole heart stress myocardial perfusion in patients with coronary artery disease. METHODS AND RESULTS Thirty-eight patients [age 61 ± 8 (21% female)] underwent 2D high resolution (spatial resolution 1.2 mm2) and 3D whole heart (in-plane spatial resolution 2.3 mm2) stress CMR at 3-T in randomized order. Myocardial ischaemic burden (%) was visually quantified as perfusion defect at peak stress perfusion subtracted from subendocardial myocardial scar and expressed as a percentage of the myocardium. Median myocardial ischaemic burden was significantly higher with 2D high resolution compared with 3D whole heart [16.1 (2.0-30.6) vs. 13.4 (5.2-23.2), P = 0.004]. There was excellent agreement between myocardial ischaemic burden (intraclass correlation coefficient 0.81; P < 0.0001), with mean ratio difference between 2D high resolution vs. 3D whole heart 1.28 ± 0.67 (95% limits of agreement -0.03 to 2.59). When using a 10% threshold for a dichotomous result for presence or absence of significant ischaemia, there was moderate agreement between the methods (κ = 0.58, P < 0.0001). CONCLUSION 2D high resolution and 3D whole heart myocardial perfusion stress CMR are comparable for detection of ischaemia. 2D high resolution gives higher values for myocardial ischaemic burden compared with 3D whole heart, suggesting that 2D high resolution is more sensitive for detection of ischaemia.
Collapse
Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Joy Shome
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, Kings College London, London, UK
| | - Ziyan Kassam
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Divaka Perera
- British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, Kings College London, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, 4th Floor Lambeth Wing, St Thomas’ Hospital, Westminster Bridge Road, London SW1 7EH, UK
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
|
7
|
Paddock S, Tsampasian V, Assadi H, Mota BC, Swift AJ, Chowdhary A, Swoboda P, Levelt E, Sammut E, Dastidar A, Broncano Cabrero J, Del Val JR, Malcolm P, Sun J, Ryding A, Sawh C, Greenwood R, Hewson D, Vassiliou V, Garg P. Clinical Translation of Three-Dimensional Scar, Diffusion Tensor Imaging, Four-Dimensional Flow, and Quantitative Perfusion in Cardiac MRI: A Comprehensive Review. Front Cardiovasc Med 2021; 8:682027. [PMID: 34307496 PMCID: PMC8292630 DOI: 10.3389/fcvm.2021.682027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
Collapse
Affiliation(s)
- Sophie Paddock
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hosamadin Assadi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Bruno Calife Mota
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eva Sammut
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Amardeep Dastidar
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Jordi Broncano Cabrero
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Javier Royuela Del Val
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Paul Malcolm
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Julia Sun
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Richard Greenwood
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - David Hewson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
|
8
|
Pan JA, Robinson AA, Yang Y, Lozano PR, McHugh S, Holland EM, Meyer CH, Taylor AM, Kramer CM, Salerno M. Diagnostic Accuracy of Spiral Whole-Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1-SPIRIT. J Magn Reson Imaging 2021; 54:1268-1279. [PMID: 33822426 DOI: 10.1002/jmri.27620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Variable density spiral (VDS) pulse sequences with motion compensated compressed sensing (MCCS) reconstruction allow for whole-heart quantitative assessment of myocardial perfusion but are not clinically validated. PURPOSE Assess performance of whole-heart VDS quantitative stress perfusion with MCCS to detect obstructive coronary artery disease (CAD). STUDY TYPE Prospective cross sectional. POPULATION Twenty-five patients with chest pain and known or suspected CAD and nine normal subjects. FIELD STRENGTH/SEQUENCE Segmented steady-state free precession (SSFP) sequence, segmented phase sensitive inversion recovery sequence for late gadolinium enhancement (LGE) imaging and VDS sequence at 1.5 T for rest and stress quantitative perfusion at eight short-axis locations. ASSESSMENT Stenosis was defined as ≥50% by quantitative coronary angiography (QCA). Visual and quantitative analysis of MRI data was compared to QCA. Quantitative analysis assessed average myocardial perfusion reserve (MPR), average stress myocardial blood flow (MBF), and lowest stress MBF of two contiguous myocardial segments. Ischemic burden was measured visually and quantitatively. STATISTICAL TESTS Student's t-test, McNemar's test, chi-square statistic, linear mixed-effects model, and area under receiver-operating characteristic curve (ROC). RESULTS Per-patient visual analysis demonstrated a sensitivity of 84% (95% confidence interval [CI], 60%-97%) and specificity of 83% [95% CI, 36%-100%]. There was no significant difference between per-vessel visual and quantitative analysis for sensitivity (69% [95% CI, 51%-84%] vs. 77% [95% CI, 60%-90%], P = 0.39) and specificity (88% [95% CI, 73%-96%] vs. 80% [95% CI, 64%-91%], P = 0.75). Per-vessel quantitative analysis ROC showed no significant difference (P = 0.06) between average MPR (0.68 [95% CI, 0.56-0.81]), average stress MBF (0.74 [95% CI, 0.63-0.86]), and lowest stress MBF (0.79 [95% CI, 0.69-0.90]). Visual and quantitative ischemic burden measurements were comparable (P = 0.85). DATA CONCLUSION Whole-heart VDS stress perfusion demonstrated good diagnostic accuracy and ischemic burden evaluation. No significant difference was seen between visual and quantitative diagnostic performance and ischemic burden measurements. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Jonathan A Pan
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Austin A Robinson
- Division of Cardiovascular Diseases, Division of Radiology, Scripps Clinic, La Jolla, California, USA
| | - Yang Yang
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.,Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patricia Rodriguez Lozano
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Stephen McHugh
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Eric M Holland
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Craig H Meyer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Angela M Taylor
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
|
9
|
Fair MJ, Gatehouse PD, Reyes E, Adluru G, Mendes J, Khan T, de Silva R, Wage R, DiBella EVR, Firmin DN. Initial investigation of free-breathing 3D whole-heart stress myocardial perfusion MRI. Glob Cardiol Sci Pract 2020; 2020:e202038. [PMID: 33598498 PMCID: PMC7868101 DOI: 10.21542/gcsp.2020.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: Myocardial first-pass perfusion imaging with MRI is well-established clinically. However, it is potentially weakened by limited myocardial coverage compared to nuclear medicine. Clinical evaluations of whole-heart MRI perfusion by 3D methods, while promising, have to date had the limit of breathhold requirements at stress. This work aims to develop a new free-breathing 3D myocardial perfusion method, and to test its performance in a small patient population. Methods: This work required tolerance to respiratory motion for stress investigations, and therefore employed a “stack-of-stars” hybrid Cartesian-radial MRI acquisition method. The MRI sequence was highly optimised for rapid acquisition and combined with a compressed sensing reconstruction. Stress and rest datasets were acquired in four healthy volunteers, and in six patients with coronary artery disease (CAD), which were compared against clinical reference information. Results: This free-breathing method produced datasets that appeared consistent with clinical reference data in detecting moderate-to-strong induced perfusion abnormalities. However, the majority of the mild defects identified clinically were not detected by the method, potentially due to the presence of transient myocardial artefacts present in the images. Discussion: The feasibility of detecting CAD using this 3D first-pass perfusion sequence during free-breathing is demonstrated. Good agreement on typical moderate-to-strong CAD cases is promising, however, questions still remain on the sensitivity of the technique to milder cases.
Collapse
Affiliation(s)
- Merlin J Fair
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Peter D Gatehouse
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Eliana Reyes
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Ganesh Adluru
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jason Mendes
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Tina Khan
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Ranil de Silva
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Rick Wage
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK
| | - Edward V R DiBella
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - David N Firmin
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| |
Collapse
|
|
10
|
Effects of nicorandil on myocardial infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: study design and protocol for the randomized controlled trial. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:519-524. [PMID: 32952527 PMCID: PMC7475214 DOI: 10.11909/j.issn.1671-5411.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous studies have shown that nicorandil has a protective effect on cardiomyocytes. However, there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) compared to the current standard of percutaneous coronary intervention (PCI) regimen. The CHANGE (China-Admini stration of Nicorandil Group) study is a multicenter, prospective, randomized, double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China, aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocar dial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.
Collapse
|
|
11
|
Ullah W, Roomi S, Abdullah HM, Mukhtar M, Ali Z, Ye P, Haas DC, Figueredo VM. Diagnostic Accuracy of Cardiac Magnetic Resonance Versus Fractional Flow Reserve: A Systematic Review and Meta-Analysis. Cardiol Res 2020; 11:145-154. [PMID: 32494324 PMCID: PMC7239594 DOI: 10.14740/cr1028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Fractional flow reserve (FFR) is considered the gold standard for diagnosis of coronary artery disease (CAD). Stress Cardiac magnetic resonance (SCMR) has been recently gaining traction as a non-invasive alternative to FFR. Methods Studies comparing the diagnostic accuracy of SCMR versus FFR were identified and analyzed using Review Manager (RevMan) 5.3 and Stata software. Results A total of 28 studies, comprising 2,387 patients, were included. The pooled sensitivity and specificity for SCMR were 86% and 86% at the patient level, and 82% and 88% at the vessel level, respectively. When the patient-level data were stratified based on the FFR thresholds, higher sensitivity and specificity (both 90%) were noted with the higher cutoff (0.75) and lower cutoff (0.8), respectively. At the vessel level, sensitivity and specificity at the lower FFR threshold were significantly higher at 88% and 89%, compared to the corresponding values for higher cutoff at 0.75. Similarly, meta-regression analysis of SCMR at higher (3T) resolution showed a higher sensitivity of 87% at the patient level and higher specificity of 90% at the vessel level. The highest sensitivity and specificity of SCMR (92% and 94%, respectively) were noted in studies with CAD prevalence greater than 60%. Conclusions SCMR has high diagnostic accuracy for CAD comparable to FFR at a spatial resolution of 3T and an FFR cut-off of 0.80. An increase in CAD prevalence further improved the specificity of SCMR.
Collapse
Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Hafez M Abdullah
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA
| | - Maryam Mukhtar
- Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Zain Ali
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Ping Ye
- Internal Medicine, University of South Dakota, Sioux Falls, SD, USA.,Avera Research Institute, Avera Health, Sioux Falls, SD, USA
| | - Donald C Haas
- Abington Hospital-Jefferson Health, Abington, PA, USA
| | | |
Collapse
|
|
12
|
Quinaglia T, Jerosch-Herold M, Coelho-Filho OR. State-of-the-Art Quantitative Assessment of Myocardial Ischemia by Stress Perfusion Cardiac Magnetic Resonance. Magn Reson Imaging Clin N Am 2020; 27:491-505. [PMID: 31279452 DOI: 10.1016/j.mric.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischemic heart disease remains the foremost determinant of death and disability across the world. Quantification of the ischemia burden is currently the preferred approach to predict event risk and to trigger adequate treatment. Cardiac magnetic resonance (CMR) can be a prime protagonist in this scenario due to its synergistic features. It allows assessment of wall motility, myocardial perfusion, and tissue scar by means of late gadolinium enhancement imaging. We discuss the clinical and preclinical aspects of gadolinium-based, perfusion CMR imaging, including the relevance of high spatial resolution and 3-dimensional whole-heart coverage, among important features of this auspicious method.
Collapse
Affiliation(s)
- Thiago Quinaglia
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Viera de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-887, Brazil
| | - Michael Jerosch-Herold
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Room L1-RA050, Mailbox #22, Boston, MA 02115, USA
| | - Otávio R Coelho-Filho
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Viera de Camargo, 126 - Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-887, Brazil; Department of Internal Medicine, Hospital das Clínicas, State University of Campinas, UNICAMP, Rua Vital Brasil, 251- Cidade Universitária "Zeferino Vaz", Campinas, São Paulo 13083-888, Brazil.
| |
Collapse
|
|
13
|
Whole Left Ventricular Coverage Versus Conventional 3-Slice Myocardial Perfusion Magnetic Resonance Imaging for the Detection of Suspected Coronary Artery Disease. Acad Radiol 2019; 26:519-525. [PMID: 29887399 DOI: 10.1016/j.acra.2018.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Sliding-window conjugate-gradient highly constrained back-projection reconstruction (SW-CG-HYPR) allows whole left ventricular coverage, improved temporal and spatial resolution, and signal-to-noise ratio compared to the conventional 3-slice saturation recovery turbo-fast low-angle shot (SR-Turbo-FLASH) sequence. We prospectively compared the diagnostic value of whole leftventricular coverage myocardial perfusion magnetic resonance imaging (MRI) and conventional 3-slice technique in patients with suspected coronary artery disease (CAD). MATERIALS AND METHODS Thirty consecutive patients with suspected CAD who were scheduled for coronary angiography underwent myocardial perfusion MRI with both SW-CG-HYPR and SR-Turbo-FLASH in random order at 3.0 T. Perfusion defects were interpreted visually by two blinded observers and were correlated to x-ray angiographic stenoses ≥50%. Receiver-operating characteristic curve analysis was used to compare the diagnostic performance of the two imaging techniques. RESULTS The image quality score of SW-CG-HYPR was significantly higher than that of SR-Turbo-FLASH (3.4 ± 0.6 vs 3.0 ± 0.7, respectively; p < 0.05). In the per-patient analysis, SW-CG-HYPR provided a higher sensitivity (94% vs 89%), specificity (83% vs 75%), and diagnostic accuracy (90% vs 83%) for the detection of CAD than SR-Turbo-FLASH. In the per-vessel analysis, the diagnostic performance of SW-CG-HYPR was significantly greater than that of SR-Turbo-FLASH for the overall detection of CAD (area under receiver-operating characteristic curve: 0.96 ± 0.02 vs 0.90 ± 0.03, respectively; p < 0.05). CONCLUSION Whole left ventricular coverage myocardial perfusion MRI has higher diagnostic accuracy compared to conventional 3-slice technique for the detection of suspected CAD.
Collapse
|
|
14
|
Gómez-Revelles S, Rossello X, Díaz-Villanueva J, López-Lima I, Sciarresi E, Estofán M, Carreras F, Pujadas S, Pons-Lladó G. Prognostic value of a new semiquantitative score system for adenosine stress myocardial perfusion by CMR. Eur Radiol 2018; 29:2263-2271. [PMID: 30406310 DOI: 10.1007/s00330-018-5774-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/24/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Cardiovascular magnetic resonance (CMR) provides information on myocardial ischemia through stress perfusion studies. In clinical practice, the grading of induced perfusion defects is performed by visual estimation of their extension. The aim of our study is to devise a score of the degree of ischemia and to test its prognostic value. METHODS Between 2009 and 2011, patients with diagnosed or suspected coronary artery disease underwent stress perfusion CMR. A score of ischemic burden was calculated on the basis of (1) stress-induced perfusion defect, (2) persistence, (3) transmurality, and (4) stress-induced contractile defect. Follow-up was censored after 4 years and primary end-point was defined by a composite of death, heart failure episode, acute coronary syndrome, and ventricular arrhythmias. Univariate and multivariate logistic regressions were used to assess the strength of the association between the CMR ischemic variables, and the composite outcome. RESULTS Forty-four of the 128 patients (34%) presented with adverse events, while 84 (66%) did not. Sixty-one patients (48%) had negative perfusion studies while 67 (52%) showed perfusion defect. Patients with positive perfusion studies and adverse events (n = 39) had higher number of segments with persistent defect (3.3 vs 1.3, p = 0.001) and highest score (19.6 vs 13.3 p = 0.012) than patients with positive perfusion studies and absence of events (n = 28). The number of segments with persistent defect showed the strongest predictive value of adverse events (OR 1.54; CI 1.19-2.00; p < 0.001). CONCLUSIONS The score of ischemic burden proposed herein has prognostic value. Persistence of a perfusion defect has the strongest impact on prognosis. KEY POINTS • Cardiovascular magnetic resonance provides information on myocardial ischemia by visual estimation of the presence of perfusion defects induced by stress. • There is not a standardized method for grading perfusion defects which, in practice, is performed by visual estimation of their extension. • As proven in this study, the integration of several parameters of perfusion defects (in addition to extension) into a semiquantitative score has prognostic value.
Collapse
Affiliation(s)
- Sonia Gómez-Revelles
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain.
- Clínica Creu Blanca, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Xavier Rossello
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | | | | | | | | | - Francesc Carreras
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
- Clínica Creu Blanca, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Pujadas
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
- Clínica Creu Blanca, Barcelona, Spain
| | - Guillem Pons-Lladó
- Cardiac Imaging Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
- Clínica Creu Blanca, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
|
15
|
Min JY, Ko SM, Song IY, Yi JG, Hwang HK, Shin JK. Comparison of the Diagnostic Accuracies of 1.5T and 3T Stress Myocardial Perfusion Cardiovascular Magnetic Resonance for Detecting Significant Coronary Artery Disease. Korean J Radiol 2018; 19:1007-1020. [PMID: 30386133 PMCID: PMC6201977 DOI: 10.3348/kjr.2018.19.6.1007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the diagnostic performance of cardiovascular magnetic resonance (CMR) myocardial perfusion at 1.5- and 3-tesla (T) for detecting significant coronary artery disease (CAD), with invasive coronary angiography (ICA) as the reference method. Materials and Methods We prospectively enrolled 281 patients (age 62.4 ± 8.3 years, 193 men) with suspected or known CAD who had undergone 1.5T or 3T CMR and ICA. Two independent radiologists interpreted perfusion defects. With ICA as the reference standard, the diagnostic performance of 1.5T and 3T CMR for identifying significant CAD (≥ 50% diameter reduction of the left main and ≥ 70% diameter reduction of other epicardial arteries) was determined. Results No differences were observed in baseline characteristics or prevalence of CAD and old myocardial infarction (MI) using 1.5T (n = 135) or 3T (n = 146) systems. Sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) for detecting significant CAD were similar between the 1.5T (84%, 64%, 74%, 76%, and 0.75 per patient and 68%, 83%, 66%, 84%, and 0.76 per vessel) and 3T (80%, 71%, 71%, 80%, and 0.76 per patient and 75%, 86%, 64%, 91%, and 0.81 per vessel) systems. In patients with multi-vessel CAD without old MI, the sensitivity, specificity, and AUC with 3T were greater than those with 1.5T on a per-vessel basis (71% vs. 36%, 92% vs. 69%, and 0.82 vs. 0.53, respectively). Conclusion 3T CMR has similar diagnostic performance to 1.5T CMR in detecting significant CAD, except for higher diagnostic performance in patients with multi-vessel CAD without old MI.
Collapse
Affiliation(s)
- Jee Young Min
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - In Young Song
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jung Geun Yi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hweung Kon Hwang
- Department of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Je Kyoun Shin
- Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| |
Collapse
|
|
16
|
Munnur RK, Cameron JD, McCormick LM, Psaltis PJ, Nerlekar N, Ko BSH, Meredith IT, Seneviratne S, Wong DTL. Diagnostic accuracy of ASLA score (a novel CT angiographic index) and aggregate plaque volume in the assessment of functional significance of coronary stenosis. Int J Cardiol 2018; 270:343-348. [PMID: 29907444 DOI: 10.1016/j.ijcard.2018.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Visual assessment of diameter-stenosis on Computed Tomography Coronary Angiography (CTCA) lacks specificity to determine functional significance of coronary artery stenosis. Percent-aggregate plaque volume (%APV) and ASLA score, which incorporates Area of Stenosis, Lesion length, and area of myocardium subtended estimated by APPROACH score (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) have been described to predict lesion specific ischaemia in focal lesions with intermediate stenosis. METHODS AND RESULTS Included were 81 patients (mean age 64.7 ± 9 years, 62% male; 94 vessels) who underwent 320- detector-row CTCA, invasive coronary angiography and fractional-flow-reserve (FFR). We examined vessels with wide range of diameter stenosis (mid to severe) and with multiple lesions. Invasive FFR of ≤0.8 was considered functionally significant. The first 54 patients (62 vessels) formed the derivation cohort. ASLA score was the best predictor of FFR ≤ 0.8 (AUC 0.83, p < 0.001) compared to %APV (0.72), CT >50% (0.76), APPROACH score (0.79), area-stenosis (0.73), diameter-stenosis (0.74), minimum-luminal-diameter (0.74), minimal-luminal-area (0.72), and lesion-length (0.67). ASLA score and not %APV, provided incremental predictive value when added to CT > 50 [(NRI 0.71, p = 0.005) vs. (NRI 0.01, p = 0.96)]. In the validation cohort of 27 patients (32 vessels), the ASLA score (AUC 0.85) was again a better predictor of FFR ≤ 0.8 compared to %APV (0.71), CT > 50% (0.66) and other CT indices. The AUC of ASLA score was superior to CTCA>50% (p = 0.001). CONCLUSION ASLA score is a novel predictor of functional significance of coronary stenosis and adds incremental predictive value to CT > 50 but %APV did not.
Collapse
Affiliation(s)
- Ravi Kiran Munnur
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia.
| | - James D Cameron
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Liam M McCormick
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Peter J Psaltis
- South Australian Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Brian S H Ko
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Ian T Meredith
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Sujith Seneviratne
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia
| | - Dennis T L Wong
- Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre) Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168, VIC, Australia; South Australian Medical Research Institute (SAHMRI), Adelaide, Australia
| |
Collapse
|
|
17
|
Nakamori S, Sakuma H, Dohi K, Ishida M, Tanigawa T, Yamada A, Takase S, Nakajima H, Sawai T, Masuda J, Nagata M, Ichikawa Y, Kitagawa K, Fujii E, Yamada N, Ito M. Combined Assessment of Stress Myocardial Perfusion Cardiovascular Magnetic Resonance and Flow Measurement in the Coronary Sinus Improves Prediction of Functionally Significant Coronary Stenosis Determined by Fractional Flow Reserve in Multivessel Disease. J Am Heart Assoc 2018; 7:JAHA.117.007736. [PMID: 29432130 PMCID: PMC5850257 DOI: 10.1161/jaha.117.007736] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Recent studies using stress‐rest perfusion cardiovascular magnetic resonance (CMR) demonstrated a close correlation between myocardial ischemia and reduced fractional flow reserve (FFR). However, its diagnostic concordance may be reduced in patients with multivessel disease. We sought to evaluate the concordance of adenosine stress‐rest perfusion CMR for predicting reduced FFR, and to determine the additive value of measuring global coronary flow reserve (CFR) in the coronary sinus in multivessel disease. Methods and Results Ninety‐six patients with angiographic luminal narrowing >50% underwent comprehensive CMR study and FFR measurements in 139 coronary vessels. FFR <0.80 was considered hemodynamically significant. Global CFR was quantified as the ratio of stress‐rest coronary sinus flow measured by phase‐contrast cine CMR. In 25 patients with single‐vessel disease, visual assessment of perfusion CMR yielded high diagnostic concordance for predicting flow‐limiting stenosis, with the area under receiver operating characteristic curve of 0.93 on a per‐patient basis. However, in 71 patients with multivessel disease, perfusion CMR underestimated flow‐limiting stenosis, resulting in the reduced area under receiver operating characteristic curve of 0.74. When CFR of <2.0 measured in the coronary sinus was considered as global myocardial ischemia, combined assessment provided correct reclassifications in 7 patients with false‐negative myocardial ischemia, and improved the diagnostic concordance to 92% sensitivity and 73% specificity with the area under receiver operating characteristic curve of 0.88 (95% confidence interval, 0.80%–0.97%, P=0.002). Conclusions Visual analysis of stress‐rest perfusion CMR has limited concordance with FFR in patients with multivessel disease. Multiparametric CMR integrating stress‐rest perfusion CMR and flow measurement in the coronary sinus is useful for detecting reduced FFR in multivessel disease.
Collapse
Affiliation(s)
- Shiro Nakamori
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takashi Tanigawa
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akimasa Yamada
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Nakajima
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Toshiki Sawai
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Jun Masuda
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Motonori Nagata
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eitaro Fujii
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Norikazu Yamada
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology, Mie University Graduate School of Medicine, Tsu, Japan
| |
Collapse
|
|
18
|
Sharif B, Motwani M, Arsanjani R, Dharmakumar R, Fish MB, Germano G, Li D, Berman DS, Slomka P. Impact of incomplete ventricular coverage on diagnostic performance of myocardial perfusion imaging. Int J Cardiovasc Imaging 2017; 34:661-669. [PMID: 29197024 PMCID: PMC5859027 DOI: 10.1007/s10554-017-1265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/26/2017] [Indexed: 12/24/2022]
Abstract
In the context of myocardial perfusion imaging (MPI) with cardiac magnetic resonance (CMR), there is ongoing debate on the merits of using technically complex acquisition methods to achieve whole-heart spatial coverage, rather than conventional 3-slice acquisition. An adequately powered comparative study is difficult to achieve given the requirement for two separate stress CMR studies in each patient. The aim of this work is to draw relevant conclusions from SPECT MPI by comparing whole-heart versus simulated 3-slice coverage in a large existing dataset. SPECT data from 651 patients with suspected coronary artery disease who underwent invasive angiography were analyzed. A computational approach was designed to model 3-slice MPI by retrospective subsampling of whole- heart data. For both whole-heart and 3-slice approaches, the diagnostic performance and the stress total perfusion deficit (TPD) score-a measure of ischemia extent/severity-were quantified and compared. Diagnostic accuracy for the 3-slice and whole-heart approaches were similar (area under the curve: 0.843 vs. 0.855, respectively; P = 0.07). The majority (54%) of cases missed by 3-slice imaging had primarily apical ischemia. Whole-heart and 3-slice TPD scores were strongly correlated (R2 = 0.93, P < 0.001) but 3-slice TPD showed a small yet significant bias compared to whole-heart TPD (- 1.19%; P < 0.0001) and the 95% limits of agreement were relatively wide (- 6.65% to 4.27%). Incomplete ventricular coverage typically acquired in 3-slice CMR MPI does not significantly affect the diagnostic accuracy. However, 3-slice MPI may fail to detect severe apical ischemia and underestimate the extent/severity of perfusion defects. Our results suggest that caution is required when comparing the ischemic burden between 3-slice and whole-heart datasets, and corroborate the need to establish prognostic thresholds specific to each approach.
Collapse
Affiliation(s)
- Behzad Sharif
- Laboratory for Translational Imaging of Microcirculation, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Manish Motwani
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Reza Arsanjani
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Division of Cardiovascular Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, 3311 Riverbend Dr, Springfield, OR, 97477, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Piotr Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
- David Geffen School of Medicine at UCLA, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| |
Collapse
|
|
19
|
Hussain ST, Paul M, Morton G, Schuster A, Chiribiri A, Perera D, Nagel E. Correlation of Fractional Flow Reserve With Ischemic Burden Measured by Cardiovascular Magnetic Resonance Perfusion Imaging. Am J Cardiol 2017; 120:1913-1919. [PMID: 29050683 DOI: 10.1016/j.amjcard.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
Abstract
Cardiovascular magnetic resonance (CMR) perfusion imaging and fractional flow reserve (FFR) assess myocardial ischemia. FFR measures the pressure loss across a stenosis determining hemodynamic significance but does not assess the area subtended by the stenotic vessel. CMR perfusion imaging measures the extent of myocardial blood flow reduction (=ischemic burden). Both techniques allow for continuous rather than categorical evaluation, but their relationship is poorly understood. This study investigates the relationship between the FFR value and the extent of myocardial ischemia. Forty-nine patients with angina underwent CMR perfusion imaging. FFR was measured in vessels with a visual diameter stenosis >40%. The extent of ischemia for each coronary artery was measured by delineating the perfusion defect on the CMR images and expressing as a percentage of the left ventricular myocardium. The correlation between the extent of ischemia measured by CMR and FFR was good (r = -0.85, p < 0.0005). The mean FFR value was 0.67 ± 0.17, and the mean perfusion defect was 8.9 ± 9.3%. An FFR value of ≥0.75 was not associated with ischemia on CMR. The maximum amount of ischemia (23.0 ± 1.5%) was found at FFR values 0.4 to 0.5. In patients with 1 vessel disease (49%), the mean ischemic burden was 15.3 ± 8.3%. In patients with 2 vessel diseases (18%), the mean ischemic burden was 26.0 ± 12%. Reproducibility for the measurement of ischemic burden was very good with a Kappa coefficient (k = 0.826, p = 0.048). In conclusion, there is good correlation between the FFR value and the amount of myocardial ischemia in the subtended myocardium.
Collapse
|
|
20
|
D'Angelo T, Nagel E. Overcoming the difficulties to adequately detect myocardial ischaemia in women. Eur Heart J Cardiovasc Imaging 2017; 18:1107-1108. [PMID: 28984892 DOI: 10.1093/ehjci/jex195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, G. Martino University Hospital, University of Messina, Via Consolare Valeria, 1, 98124 Messina ME, Italy.,Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Theodor-Stern-Kai 7; 60590 Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Theodor-Stern-Kai 7; 60590 Frankfurt am Main, Germany
| |
Collapse
|
|
21
|
Pontre B, Cowan BR, DiBella E, Kulaseharan S, Likhite D, Noorman N, Tautz L, Tustison N, Wollny G, Young AA, Suinesiaputra A. An Open Benchmark Challenge for Motion Correction of Myocardial Perfusion MRI. IEEE J Biomed Health Inform 2017; 21:1315-1326. [PMID: 28880152 PMCID: PMC5658235 DOI: 10.1109/jbhi.2016.2597145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cardiac magnetic resonance perfusion examinations enable noninvasive quantification of myocardial blood flow. However, motion between frames due to breathing must be corrected for quantitative analysis. Although several methods have been proposed, there is a lack of widely available benchmarks to compare different algorithms. We sought to compare many algorithms from several groups in an open benchmark challenge. Nine clinical studies from two different centers comprising normal and diseased myocardium at both rest and stress were made available for this study. The primary validation measure was regional myocardial blood flow based on the transfer coefficient (Ktrans), which was computed using a compartment model and the myocardial perfusion reserve (MPR) index. The ground truth was calculated using contours drawn manually on all frames by a single observer, and visually inspected by a second observer. Six groups participated and 19 different motion correction algorithms were compared. Each method used one of three different motion models: rigid, global affine, or local deformation. The similarity metric also varied with methods employing either sum-of-squared differences, mutual information, or cross correlation. There were no significant differences in Ktrans or MPR compared across different motion models or similarity metrics. Compared with the ground truth, only Ktrans for the sum-of-squared differences metric, and for local deformation motion models, had significant bias. In conclusion, the open benchmark enabled evaluation of clinical perfusion indices over a wide range of methods. In particular, there was no benefit of nonrigid registration techniques over the other methods evaluated in this study. The benchmark data and results are available from the Cardiac Atlas Project ( www.cardiacatlas.org).
Collapse
|
|
22
|
Schwitter J, Gold MR, Al Fagih A, Lee S, Peterson M, Ciuffo A, Zhang Y, Kristiansen N, Kanal E, Sommer T. Image Quality of Cardiac Magnetic Resonance Imaging in Patients With an Implantable Cardioverter Defibrillator System Designed for the Magnetic Resonance Imaging Environment. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004025. [PMID: 27151268 DOI: 10.1161/circimaging.115.004025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system. METHODS AND RESULTS The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades 1-3: good quality, grades 6-7: nondiagnostic) and measuring ICD- and lead-related artifact size. Good to moderate image quality (grades 1-5) was obtained in 53% and 74% of SSFP and FGE acquisitions, respectively, covering the left ventricle, and in 69% and 84%, respectively, covering the right ventricle. Odds for better image quality were greater for right ventricle versus left ventricle (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P<0.0001) and greater for FGE versus SSFP (odds ratio, 3.5; 95% confidence interval, 2.5-4.8; P<0.0001). Compared with SSFP, ICD-related artifacts on FGE were smaller (141±65 versus 75±57 mm, respectively; P<0.0001). Lead artifacts were much smaller than ICD artifacts (P<0.0001). CONCLUSIONS FGE yields good to moderate quality in 74% of left ventricle and 84% of right ventricle acquisitions and performs better than SSFP in patients with an MRI-conditional ICD system. In these patients, cardiac MRI can offer diagnostic information in most cases. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02117414.
Collapse
Affiliation(s)
- Juerg Schwitter
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
| | - Michael R Gold
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Ahmed Al Fagih
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Sung Lee
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Michael Peterson
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Allen Ciuffo
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Yan Zhang
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Nina Kristiansen
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Emanuel Kanal
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | - Torsten Sommer
- From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.)
| | | |
Collapse
|
|
23
|
Vogel-Claussen J, Elshafee AS, Kirsch J, Brown RK, Hurwitz LM, Javidan-Nejad C, Julsrud PR, Kramer CM, Krishnamurthy R, Laroia AT, Leipsic JA, Panchal KK, Shah AB, White RD, Woodard PK, Abbara S. ACR Appropriateness Criteria ® Dyspnea—Suspected Cardiac Origin. J Am Coll Radiol 2017; 14:S127-S137. [DOI: 10.1016/j.jacr.2017.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/17/2022]
|
|
24
|
Shi C, Zhang D, Cao K, Zhang T, Luo L, Liu X, Zhang H. A study of noninvasive fractional flow reserve derived from a simplified method based on coronary computed tomography angiography in suspected coronary artery disease. Biomed Eng Online 2017; 16:43. [PMID: 28407768 PMCID: PMC5391576 DOI: 10.1186/s12938-017-0330-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. Determining non-invasive FFR based on coronary computed tomographic angiography datasets using computational fluid dynamics tends to be a demanding process. Therefore, the diagnostic performance of a simplified method for the calculation of FFRCTA requires further evaluation. Objectives The aim of this study was to investigate the diagnostic performance of FFRCTA calculated based on a simplified method by referring to the invasive FFR in patient-specific coronary arteries and clinical decision-making. Methods Twenty-nine subjects included in this study underwent CCTA before undergoing clinically indicated invasive coronary angiography for suspected coronary artery disease. Pulsatile flow simulation and a novel boundary condition were used to obtain FFRCTA based on the CCTA datasets. The Pearson correlation, Bland–Altman plots and the diagnostic performance of FFRCTA and CCTA stenosis were analyzed by comparison to the invasive FFR reference standard. Ischaemia was defined as an FFR or FFRCTA ≤0.80, and anatomically obstructive CAD was defined as a CCTA stenosis >50%. Results FFRCTA and invasive FFR were well correlated (r = 0.742, P = 0.001). Slight systematic underestimation was found in FFRCTA (mean difference 0.03, standard deviation 0.05, P = 0.001). The area under the receiver-operating characteristic curve was 0.93 for FFRCTA and 0.75 for CCTA on a per-vessel basis. Per-patient accuracy, sensitivity and specificity were 79.3, 93.7 and 61.5%, respectively, for FFRCTA and 62.1, 87.5 and 30.7%, respectively, for CCTA. Per-vessel accuracy, sensitivity and specificity were 80.6, 94.1 and 68.4%, respectively, for FFRCTA and 61.6, 88.2 and 36.8%, respectively, for CCTA. Conclusions FFRCTA derived from pulsatile simulation with a simplified novel boundary condition was in good agreement with invasive FFR and showed better diagnostic performance compared to CCTA, suggesting that the simplified method has the potential to be an alternative and accurate way to assess the haemodynamic characteristics for coronary stenosis.
Collapse
Affiliation(s)
- Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, 613 Huangpu W Ave, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, 613 Huangpu W Ave, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Kunlin Cao
- Research and Development Department, Shenzhen Keya Medical Technology, Co., Ltd., Longgang District, Shenzhen, 518116, Guangdong Province, China
| | - Tao Zhang
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, 613 Huangpu W Ave, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital, Jinan University, 613 Huangpu W Ave, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| | - Xin Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave. Xili University Town, Nanshan District, Shenzhen, 518055, Guangdong Province, China.
| | - Heye Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Ave. Xili University Town, Nanshan District, Shenzhen, 518055, Guangdong Province, China
| |
Collapse
|
|
25
|
Yang Y, Zhao L, Chen X, Shaw PW, Gonzalez JA, Epstein FH, Meyer CH, Kramer CM, Salerno M. Reduced field of view single-shot spiral perfusion imaging. Magn Reson Med 2017; 79:208-216. [PMID: 28321908 DOI: 10.1002/mrm.26664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To develop a single-shot spiral perfusion pulse sequence with outer-volume suppression (OVS) to achieve whole-heart coverage with a short temporal footprint of 10 ms per slice location. METHODS A highly accelerated single-shot variable density spiral pulse sequence with an integrated OVS module for reduced field of view (rFOV) perfusion imaging with 2 mm spatial resolution was developed and evaluated in simulations, phantom experiments and in clinical patients with (n = 8) or without (n = 8) OVS. Images were reconstructed by block low-rank sparsity with motion guidance (BLOSM) and graded by two cardiologists on a 5-point scale (1, excellent; 5, poor). RESULTS Simulation and phantom results showed that OVS effectively suppressed the signal outside the desired field of view (FOV). Clinical patient data demonstrated high quality perfusion images with rFOV. The average image quality scores of full FOV cases and rFOV cases were 3.1 ± 0.64 and 2.3 ± 0.46, respectively, (P = 0.02) from cardiologist 1 and 2.5 ± 0.54 and 1.8 ± 0.47, respectively, (P = 0.04) from cardiologist 2, showing superior image quality for the rFOV images compared with the full FOV images. CONCLUSION A single-shot spiral perfusion sequence that uses OVS and BLOSM performs perfusion imaging with a very short temporal footprint per image supporting whole-heart coverage with good image quality. Magn Reson Med 79:208-216, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- Yang Yang
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Li Zhao
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Xiao Chen
- Medical Imaging Technologies, Siemens Medical Solutions USA, Inc
| | - Peter W Shaw
- Cardiology Professional Services, Berkshire Medical Center, Pittsfield, Massachusetts, USA
| | - Jorge A Gonzalez
- Division of Cardiovascular Disease, Scripps Clinic, John R. Anderson V Medical Pavilion, La Jolla, California, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Departments of Medicine, Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA.,Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA.,Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
|
26
|
Foley JRJ, Plein S, Greenwood JP. Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques. World J Cardiol 2017; 9:92-108. [PMID: 28289524 PMCID: PMC5329750 DOI: 10.4330/wjc.v9.i2.92] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/15/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD.
Collapse
|
|
27
|
Lindsey BD, Shelton SE, Martin KH, Ozgun KA, Rojas JD, Foster FS, Dayton PA. High Resolution Ultrasound Superharmonic Perfusion Imaging: In Vivo Feasibility and Quantification of Dynamic Contrast-Enhanced Acoustic Angiography. Ann Biomed Eng 2016; 45:939-948. [PMID: 27832421 DOI: 10.1007/s10439-016-1753-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
Mapping blood perfusion quantitatively allows localization of abnormal physiology and can improve understanding of disease progression. Dynamic contrast-enhanced ultrasound is a low-cost, real-time technique for imaging perfusion dynamics with microbubble contrast agents. Previously, we have demonstrated another contrast agent-specific ultrasound imaging technique, acoustic angiography, which forms static anatomical images of the superharmonic signal produced by microbubbles. In this work, we seek to determine whether acoustic angiography can be utilized for high resolution perfusion imaging in vivo by examining the effect of acquisition rate on superharmonic imaging at low flow rates and demonstrating the feasibility of dynamic contrast-enhanced superharmonic perfusion imaging for the first time. Results in the chorioallantoic membrane model indicate that frame rate and frame averaging do not affect the measured diameter of individual vessels observed, but that frame rate does influence the detection of vessels near and below the resolution limit. The highest number of resolvable vessels was observed at an intermediate frame rate of 3 Hz using a mechanically-steered prototype transducer. We also demonstrate the feasibility of quantitatively mapping perfusion rate in 2D in a mouse model with spatial resolution of ~100 μm. This type of imaging could provide non-invasive, high resolution quantification of microvascular function at penetration depths of several centimeters.
Collapse
Affiliation(s)
- Brooks D Lindsey
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Sarah E Shelton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - K Heath Martin
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Kathryn A Ozgun
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Juan D Rojas
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | | | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA. .,Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
|
28
|
Peterzan MA, Rider OJ, Anderson LJ. The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure. Card Fail Rev 2016; 2:115-122. [PMID: 28785465 PMCID: PMC5490982 DOI: 10.15420/cfr.2016.2.2.115] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/24/2016] [Indexed: 01/03/2023] Open
Abstract
Cardiovascular imaging is key for the assessment of patients with heart failure. Today, cardiovascular magnetic resonance imaging plays an established role in the assessment of patients with suspected and confirmed heart failure syndromes, in particular identifying aetiology. Its role in informing prognosis and guiding decisions around therapy are evolving. Key strengths include its accuracy; reproducibility; unrestricted field of view; lack of radiation; multiple abilities to characterise myocardial tissue, thrombus and scar; as well as unparalleled assessment of left and right ventricular volumes. T2* has an established role in the assessment and follow-up of iron overload cardiomyopathy and a role for T1 in specific therapies for cardiac amyloid and Anderson-Fabry disease is emerging.
Collapse
Affiliation(s)
- Mark A Peterzan
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Oliver J Rider
- University of Oxford Centre for Clinical Magnetic Resonance Research,John Radcliffe Hospital, Oxford, UK
| | - Lisa J Anderson
- Cardiology Clinical Academic GroupSt George’s Hospital, London, UK
| |
Collapse
|
|
29
|
The assessment of ischaemic burden: validation of a functional jeopardy score against cardiovascular magnetic resonance perfusion imaging. Clin Res Cardiol 2016; 106:259-270. [PMID: 27766423 DOI: 10.1007/s00392-016-1047-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/11/2016] [Indexed: 01/03/2023]
Abstract
AIMS This study assesses the relationship between classical anatomical jeopardy scores, functional jeopardy scores (combined anatomical and haemodynamic data), and the extent of ischaemia identified on cardiovascular magnetic resonance (CMR) perfusion imaging. METHODS AND RESULTS In 42 patients with stable angina and suspected coronary artery disease (CAD), CMR perfusion imaging was performed. Fractional Flow Reserve (FFR) was measured in vessels with ≥50 % stenosis. The APPROACH and BCIS jeopardy scores were calculated based on QCA results with both a 70 % (APP70 and BCIS70) and a 50 % stenosis (APP50, and BCIS50) used as the threshold for significance, as well as after integration of FFR and compared with the extent of ischaemia identified on CMR. The correlation between the extent of ischaemia measured by CMR and the anatomical jeopardy scores was moderate (APPROACH: r = 0.58; BCIS: r = 0.48, p = 0.001). Integrating physiological information improved this significantly to r = 0.82, p = 0.0001 for APPROACH and r = 0.82, p = 0.0001 for BCIS scores (z-statistic = -2.04, p = 0.04; z-statistic = -2.63, p = 0.009). In relation to CMR, the APPROACH and BCIS scores overestimated the volume of ischaemic myocardium by 29.2 and 25.2 %, respectively, which was reduced to 12.8 and 12 % after integrating functional data. CONCLUSIONS Anatomical and functional jeopardy scores overestimate ischaemic burden when compared to CMR. Integrating physiological information from FFR to generate a functional score improves ischaemic burden estimation.
Collapse
|
|
30
|
Zakkaroff C, Biglands JD, Greenwood JP, Plein S, Boyle RD, Radjenovic A, Magee DR. Investigation into diagnostic accuracy of common strategies for automated perfusion motion correction. J Med Imaging (Bellingham) 2016; 3:024002. [PMID: 27213166 DOI: 10.1117/1.jmi.3.2.024002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/26/2016] [Indexed: 11/14/2022] Open
Abstract
Respiratory motion is a significant obstacle to the use of quantitative perfusion in clinical practice. Increasingly complex motion correction algorithms are being developed to correct for respiratory motion. However, the impact of these improvements on the final diagnosis of ischemic heart disease has not been evaluated. The aim of this study was to compare the performance of four automated correction methods in terms of their impact on diagnostic accuracy. Three strategies for motion correction were used: (1) independent translation correction for all slices, (2) translation correction for the basal slice with transform propagation to the remaining two slices assuming identical motion in the remaining slices, and (3) rigid correction (translation and rotation) for the basal slice. There were no significant differences in diagnostic accuracy between the manual and automatic motion-corrected datasets ([Formula: see text]). The area under the curve values for manual motion correction and automatic motion correction were 0.93 and 0.92, respectively. All of the automated motion correction methods achieved a comparable diagnostic accuracy to manual correction. This suggests that the simplest automated motion correction method (method 2 with translation transform for basal location and transform propagation to the remaining slices) is a sufficiently complex motion correction method for use in quantitative myocardial perfusion.
Collapse
Affiliation(s)
| | - John D Biglands
- University of Leeds, Division of Medical Physics, Leeds LS2 9JT, United Kingdom; University of Leeds, Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds LS2 9JT, United Kingdom
| | - John P Greenwood
- University of Leeds, Division of Medical Physics, Leeds LS2 9JT, United Kingdom; University of Leeds, Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds LS2 9JT, United Kingdom
| | - Sven Plein
- University of Leeds, Division of Medical Physics, Leeds LS2 9JT, United Kingdom; University of Leeds, Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds LS2 9JT, United Kingdom
| | - Roger D Boyle
- University of Aberystwyth , Institute of Biological, Environmental and Rural Sciences, Aberystwyth, Ceredigion SY23 3DA, United Kingdom
| | - Aleksandra Radjenovic
- University of Glasgow , Institute of Cardiovascular and Medical Sciences, Glasgow Cardiovascular Centre, Glasgow G12 8QQ, United Kingdom
| | - Derek R Magee
- University of Leeds , School of Computing, Leeds LS2 9JT, United Kingdom
| |
Collapse
|
|
31
|
Chabiniok R, Wang VY, Hadjicharalambous M, Asner L, Lee J, Sermesant M, Kuhl E, Young AA, Moireau P, Nash MP, Chapelle D, Nordsletten DA. Multiphysics and multiscale modelling, data-model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics. Interface Focus 2016; 6:20150083. [PMID: 27051509 PMCID: PMC4759748 DOI: 10.1098/rsfs.2015.0083] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With heart and cardiovascular diseases continually challenging healthcare systems worldwide, translating basic research on cardiac (patho)physiology into clinical care is essential. Exacerbating this already extensive challenge is the complexity of the heart, relying on its hierarchical structure and function to maintain cardiovascular flow. Computational modelling has been proposed and actively pursued as a tool for accelerating research and translation. Allowing exploration of the relationships between physics, multiscale mechanisms and function, computational modelling provides a platform for improving our understanding of the heart. Further integration of experimental and clinical data through data assimilation and parameter estimation techniques is bringing computational models closer to use in routine clinical practice. This article reviews developments in computational cardiac modelling and how their integration with medical imaging data is providing new pathways for translational cardiac modelling.
Collapse
Affiliation(s)
- Radomir Chabiniok
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - Vicky Y. Wang
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Myrianthi Hadjicharalambous
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Liya Asner
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Jack Lee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| | - Maxime Sermesant
- Inria, Asclepios team, 2004 route des Lucioles BP 93, Sophia Antipolis Cedex 06902, France
| | - Ellen Kuhl
- Departments of Mechanical Engineering, Bioengineering, and Cardiothoracic Surgery, Stanford University, 496 Lomita Mall, Durand 217, Stanford, CA 94306, USA
| | - Alistair A. Young
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Philippe Moireau
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - Martyn P. Nash
- Auckland Bioengineering Institute, University of Auckland, 70 Symonds Street, Auckland, New Zealand
- Department of Engineering Science, University of Auckland, 70 Symonds Street, Auckland, New Zealand
| | - Dominique Chapelle
- Inria and Paris-Saclay University, Bâtiment Alan Turing, 1 rue Honoré d'Estienne d'Orves, Campus de l'Ecole Polytechnique, Palaiseau 91120, France
| | - David A. Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas’ Hospital, London SE1 7EH, UK
| |
Collapse
|
|
32
|
Jiang B, Cai W, Lv X, Liu H. Diagnostic Performance and Clinical Utility of Myocardial Perfusion MRI for Coronary Artery Disease with Fractional Flow Reserve as the Standard Reference: A Meta-analysis. Heart Lung Circ 2016; 25:1031-8. [PMID: 27108100 DOI: 10.1016/j.hlc.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stress myocardial perfusion imaging is a noninvasive alternative to invasive fractional flow reserve for evaluating haemodynamically significant coronary artery disease. We aimed to systematically analyse the diagnostic performance and clinical utility of myocardial perfusion MRI for coronary artery disease (CAD) using fractional flow reserve (FFR) as the standard reference. METHODS We searched PubMed, EMBASE, and Cochrane Library to July 2015 for studies using perfusion MR as a diagnostic test for CAD versus FFR. The meta-analysis was performed based on Cochrane guideline. RESULTS We identified 20 studies with 1,570 patients. Pooled analyses were performed at per-patient level (1,041 patients) and per-territory level (2,690 coronary territories). The sensitivity, specificity, area under sROC curve were 0.88 (95% CI: 0.85, 0.91), 0.88 (95% CI: 0.84, 0.90), and 0.94 (95% CI: 0.92, 0.96) at per-patient level, and 0.86 (95% CI: 0.81, 0.90), 0.88 (95% CI: 0.84, 0.92), and 0.93 (95% CI: 0.91, 0.95) at per-territory level. Post-test probability was altered by positive (likelihood ratio) LR of 7.1 (95% CI: 5.6, 9.0) and negative LR of 0.13 (95% CI: 0.10, 0.17) based on Bayes' theorem. CONCLUSIONS Diagnostic accuracy of myocardial perfusion MRI for CAD is high and can alter the post-test probability of CAD.
Collapse
Affiliation(s)
- Binghu Jiang
- Department of Radiology, Sir Yifu Hospital Affiliated with Nanjing Medical University, China
| | - Wei Cai
- Department of Cardiology, BenQ Medical Center, Nanjing Medical University, China
| | - Xianjun Lv
- Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, China
| | - Huaijun Liu
- Department of Radiology, the Second Hospital of Hebei Medical University, China.
| |
Collapse
|
|
33
|
Sawlani RN, Collins JD. Cardiac MRI and Ischemic Heart Disease: Role in Diagnosis and Risk Stratification. Curr Atheroscler Rep 2016; 18:23. [DOI: 10.1007/s11883-016-0576-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
|
34
|
Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1734190. [PMID: 27088083 PMCID: PMC4806267 DOI: 10.1155/2016/1734190] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
Abstract
Technological advances in magnetic resonance imaging (MRI) and computed tomography (CT), including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET). This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD), as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.
Collapse
|
|
35
|
Fluttaz A, Rodière M, Bourre JC, Jankowski A, Descotes-Genon V, Riou L, Broisat A, Ghezzi C, Djaileb L, Calizzano A, Machecourt J, Vanzetto G, Fagret D, Barone-Rochette G. Know the strengths and weaknesses of ischemia tests to guide the therapeutic strategy of a patient with multi-vessel disease. Int J Cardiol 2016; 206:64-7. [DOI: 10.1016/j.ijcard.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/24/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
|
|
36
|
McDiarmid AK, Ripley DP, Mohee K, Kozerke S, Greenwood JP, Plein S, Motwani M. Three-dimensional whole-heart vs. two-dimensional high-resolution perfusion-CMR: a pilot study comparing myocardial ischaemic burden. Eur Heart J Cardiovasc Imaging 2015; 17:900-8. [PMID: 26450417 DOI: 10.1093/ehjci/jev231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/26/2015] [Indexed: 01/20/2023] Open
Abstract
AIMS Typically, myocardial perfusion imaging with two-dimensional (2D) cardiovascular magnetic resonance (CMR) acquires data in three to four myocardial slices at a spatial resolution of 2-3 mm. However, accelerated data acquisition can facilitate higher spatial resolution (<2 mm) or three-dimensional (3D) whole-heart coverage (up to 16 slices). This study aims to compare image quality, diagnostic confidence, and quantitation of myocardial ischaemic burden (MIB) between 2D high-resolution and 3D whole-heart perfusion-CMR. METHODS AND RESULTS Twenty-seven patients with stable angina underwent both high-resolution 2D and whole-heart 3D perfusion-CMR. Total perfusion defect (TPD) and total scar burden (TSB) areas were contoured and expressed as percentage myocardium. MIB was calculated by subtracting TSB from TPD. Image quality, artefact, and diagnostic confidence scores were similar for both techniques (P>0.05). The mean MIB from high-resolution and 3D acquisition was similar (4.3±5.2% vs. 4.1±4.9%; P=0.81), with a strong correlation between techniques (r=0.72; P<0.001). There was no systematic bias for estimates of MIB between techniques [mean bias=-0.17%, 95% confidence interval (CI): -1.7 to -1.3%] and the 95% limits of agreement were -7.5 to 7.2%. When used to categorize MIB as >10% or <10%, there was only fair agreement between the two techniques (κ=0.29, 95% CI: -0.12 to 0.70). CONCLUSION There is strong correlation and broad agreement between estimates of MIB from both techniques. However, the 95% limits of agreement are relatively wide and therefore a larger comparative study is needed before they can be considered interchangeable-particularly around the clinically relevant 10% threshold.
Collapse
Affiliation(s)
- Adam K McDiarmid
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - David P Ripley
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Kevin Mohee
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - John P Greenwood
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Manish Motwani
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
|
37
|
Guaricci AI, Brunetti ND, Marra MP, Tarantini G, di Biase M, Pontone G. Diagnosis and prognosis of ischemic heart disease. J Cardiovasc Med (Hagerstown) 2015; 16:653-62. [DOI: 10.2459/jcm.0000000000000267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
|
38
|
Fair MJ, Gatehouse PD, DiBella EVR, Firmin DN. A review of 3D first-pass, whole-heart, myocardial perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2015; 17:68. [PMID: 26231784 PMCID: PMC4522116 DOI: 10.1186/s12968-015-0162-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/23/2015] [Indexed: 01/19/2023] Open
Abstract
A comprehensive review is undertaken of the methods available for 3D whole-heart first-pass perfusion (FPP) and their application to date, with particular focus on possible acceleration techniques. Following a summary of the parameters typically desired of 3D FPP methods, the review explains the mechanisms of key acceleration techniques and their potential use in FPP for attaining 3D acquisitions. The mechanisms include rapid sequences, non-Cartesian k-space trajectories, reduced k-space acquisitions, parallel imaging reconstructions and compressed sensing. An attempt is made to explain, rather than simply state, the varying methods with the hope that it will give an appreciation of the different components making up a 3D FPP protocol. Basic estimates demonstrating the required total acceleration factors in typical 3D FPP cases are included, providing context for the extent that each acceleration method can contribute to the required imaging speed, as well as potential limitations in present 3D FPP literature. Although many 3D FPP methods are too early in development for the type of clinical trials required to show any clear benefit over current 2D FPP methods, the review includes the small but growing quantity of clinical research work already using 3D FPP, alongside the more technical work. Broader challenges concerning FPP such as quantitative analysis are not covered, but challenges with particular impact on 3D FPP methods, particularly with regards to motion effects, are discussed along with anticipated future work in the field.
Collapse
Affiliation(s)
- Merlin J Fair
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Peter D Gatehouse
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| | - Edward V R DiBella
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, USA.
| | - David N Firmin
- National Heart & Lung Institute, Imperial College London, London, UK.
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
| |
Collapse
|
|
39
|
Manka R, Wissmann L, Gebker R, Jogiya R, Motwani M, Frick M, Reinartz S, Schnackenburg B, Niemann M, Gotschy A, Kuhl C, Nagel E, Fleck E, Marx N, Luescher TF, Plein S, Kozerke S. Multicenter evaluation of dynamic three-dimensional magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.003061. [PMID: 25901043 DOI: 10.1161/circimaging.114.003061] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND 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. METHODS AND RESULTS 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. CONCLUSIONS In this multicenter study, 3D myocardial perfusion CMR proved highly diagnostic for the detection of significant CAD as defined by FFR.
Collapse
Affiliation(s)
- Robert Manka
- 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.)
| | - Lukas Wissmann
- 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.)
| | - Rolf Gebker
- 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.)
| | - Roy Jogiya
- 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.)
| | - Manish Motwani
- 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.)
| | - Michael Frick
- 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.)
| | - Sebastian Reinartz
- 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.)
| | - Bernhard Schnackenburg
- 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.)
| | - Markus Niemann
- 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.)
| | - Alexander Gotschy
- 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.)
| | - Christiane Kuhl
- 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.)
| | - Eike Nagel
- 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.)
| | - Eckart Fleck
- 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.)
| | - Nikolaus Marx
- 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.)
| | - Thomas F Luescher
- 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.)
| | - Sven Plein
- 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.)
| | - Sebastian Kozerke
- 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.).
| |
Collapse
|
|
40
|
Qi X, Fan G, Zhu D, Ma W, Yang C. Comprehensive assessment of coronary fractional flow reserve. Arch Med Sci 2015; 11:483-93. [PMID: 26170840 PMCID: PMC4495145 DOI: 10.5114/aoms.2015.52351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 07/30/2013] [Accepted: 08/01/2013] [Indexed: 02/06/2023] Open
Abstract
Fractional flow reserve (FFR) is considered nowadays as the gold standard for invasive assessment of physiologic stenosis significance and an indispensable tool for decision-making in coronary revascularization. Robust studies have shown that FFR is more effective in accurately identifying which lesions should be stented, and revascularization guided by FFR improves the outcome of coronary artery disease in patients. Therefore, FFR has been upgraded to a class A recommendation in current guidelines when the ischemic potential for specific target lesions is controversial. This article reviews the laboratory practice, functional evaluation of FFR as a gold standard and its emerging clinical application. In addition, novel noninvasive technologies of FFR measurement are discussed in depth.
Collapse
Affiliation(s)
- Xiaolong Qi
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoxin Fan
- Division of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deqiu Zhu
- Division of Pharmacy, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wanrong Ma
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqing Yang
- Division of Gastroenterology, Institute of Digestive Disease, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
|
41
|
Sharif B, Arsanjani R, Dharmakumar R, Bairey Merz CN, Berman DS, Li D. All-systolic non-ECG-gated myocardial perfusion MRI: Feasibility of multi-slice continuous first-pass imaging. Magn Reson Med 2015; 74:1661-74. [PMID: 26052843 DOI: 10.1002/mrm.25752] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/03/2015] [Accepted: 04/04/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop and test the feasibility of a new method for non-ECG-gated first-pass perfusion (FPP) cardiac MR capable of imaging multiple short-axis slices at the same systolic cardiac phase. METHODS A magnetization-driven pulse sequence was developed for non-ECG-gated FPP imaging without saturation-recovery preparation using continuous slice-interleaved radial sampling. The image reconstruction method, dubbed TRACE, used self-gating based on reconstruction of a real-time image-based navigator combined with reference-constrained compressed sensing. Data from ischemic animal studies (n = 5) was used in a simulation framework to evaluate temporal fidelity. Healthy subjects (n = 5) were studied using both the proposed approach and the conventional method to compare the myocardial contrast-to-noise ratio (CNR). Patients (n = 2) underwent adenosine stress studies using the proposed method. RESULTS Temporal fidelity of the developed method was shown to be sufficient at high heart-rates. The healthy volunteers studies demonstrated normal perfusion and no dark-rim artifacts. Compared with the conventional scheme, myocardial CNR for the proposed method was slightly higher (8.6 ± 0.6 versus 8.0 ± 0.7). Patient studies showed stress-induced perfusion defects consistent with invasive angiography. CONCLUSION The presented methods and results demonstrate feasibility of the proposed approach for high-resolution non-ECG-gated FPP imaging of 3 myocardial slices at the same systolic phase, and indicate its potential for achieving desirable image quality (high CNR and no dark-rim artifacts).
Collapse
Affiliation(s)
- Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Reza Arsanjani
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Rohan Dharmakumar
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - C Noel Bairey Merz
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
|
42
|
AlJaroudi W, Isma'eel H, El Merhi F, Assad T, Hourani M. Appropriateness and diagnostic yield of cardiac magnetic resonance imaging from a tertiary referral center in the Middle East. Cardiovasc Diagn Ther 2015; 5:88-97. [PMID: 25984448 DOI: 10.3978/j.issn.2223-3652.2014.11.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/22/2014] [Indexed: 11/14/2022]
Abstract
PURPOSE Cardiac magnetic resonance imaging (CMRI) is a novel non-invasive modality with many potential indications, and was recently introduced in Lebanon. We sought to assess the appropriateness and diagnostic yield of CMR studies performed at a tertiary referral center from the Middle East since the inception of the program. METHODS All patients who underwent CMR studies between January 1(st) 2013 and June 18(th) 2014 were enrolled in this study. CMR reports were retrospectively reviewed. The study indication, clinical history, and findings were extracted and analyzed. The appropriateness of the study was judged according to the 2010 updated Asian Society of Cardiac Imaging guidelines. RESULTS There were a total of 142 patients [mean age 42.1 (SD: 18) years, 24.6% females] that underwent CMR study. Two-thirds of studies were performed on an outpatient basis, and outside referrals constituted 16.2% of the entire cohort. The cardiologists referred 122 cases (86%) with main contribution from electrophysiology and imaging specialists. Of the 142 cases, 12 (8.4%) were not indicated and added little value. Of the remaining 130 appropriate studies (appropriateness level A8-A9), one-third had an incorrect diagnosis prior to CMR, and 8% had relevant findings that were missed on other studies but captured by CMR. Furthermore, CMR confirmed the diagnosis in 28% of the cases, provided relevant information on scar burden, shunt quantification, and ruled out infiltrative disease in the remaining patients. Also, CMR demonstrated the presence of scar in 45 of patients, among whom 20 (44%) had significant scar volume quantification (>5% of left ventricular myocardium). Finally, 9% of patients had a relevant extra-cardiac finding that needed further investigation. CONCLUSIONS Despite the recent launch of the CMR program at our institution, the majority of studies were appropriately indicated, provided relevant data and were clinically useful. Inappropriate or uncertain studies did not provide relevant data, and should be further minimized to avoid unnecessary costs and downstream testing. Large prospective CMR database with clinical follow-up is needed to provide more insight about cardiovascular disease and outcomes in our population.
Collapse
Affiliation(s)
- Wael AlJaroudi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hussain Isma'eel
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi El Merhi
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tony Assad
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mukbil Hourani
- 1 Division of Cardiovascular Medicine, 2 Division of Radiology, American University of Beirut Medical Center, Beirut, Lebanon ; 3 Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
|
43
|
Pan J, Huang S, Lu Z, Li J, Wan Q, Zhang J, Gao C, Yang X, Wei M. Comparison of myocardial transmural perfusion gradient by magnetic resonance imaging to fractional flow reserve in patients with suspected coronary artery disease. Am J Cardiol 2015; 115:1333-40. [PMID: 25796365 DOI: 10.1016/j.amjcard.2015.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/07/2015] [Accepted: 02/07/2015] [Indexed: 11/15/2022]
Abstract
The goal of this study was to evaluate the diagnostic accuracy of transmural perfusion gradient (TPG) and transmural perfusion gradient reserve (TPGR) with 3.0 T cardiac magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) to detect coronary artery stenosis. Quantitative analysis of myocardial perfusion with CMR to diagnosis coronary artery disease (CAD) has been widely accepted. However, traditional transmural myocardial perfusion analysis with CMR neglects that endocardium is more vulnerable to ischemia than epicardium. TPG and TPGR can take the inhomogenous perfusion impairment into account and be more sensitive and specific for diagnosis of CAD. In this study, 71 patients (57 men, age 60.1 ± 6.4 years) with known or suspected CAD referred for invasive angiography study underwent rest and adenosine-induced stress CMR perfusion imaging scan. FFR was attempted to be measured in all major epicardial coronary arteries. FFR ≤0.75 was regarded to indicate a hemodynamic significant coronary lesion. A TPG ≤0.85 predicted significant CAD with sensitivity and specificity of 74.55% and 83.65%, respectively. Sensitivity and specificity of TPGR ≤0.81 were 90.91% and 89.94%, respectively. Area under the receiver-operating curve to detect FFR ≤0.75 was 0.86 for TPG and 0.95 for TPGR. TPGR yielded significantly better sensitivity and specificity for diagnosis of CAD than traditional myocardial blood flow, myocardial perfusion reserve, and TPG (p < 0.0001). In conclusion, TPG and TPGR analyses with MRI are capable of detecting hemodynamic stenosis of coronary artery and superior to traditional myocardial perfusion analysis. Furthermore, TPGR appears to be superior to TPG in the diagnosis of coronary artery stenosis.
Collapse
Affiliation(s)
- Jingwei Pan
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Siyi Huang
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jingbo Li
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qing Wan
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chengjie Gao
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin Yang
- School of Electronic Information and Electrical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Meng Wei
- Department of Cardiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
| |
Collapse
|
|
44
|
Song KD, Kim SM, Choe YH, Jung W, Lee SC, Chang SA, Choi YH, Sung J. Integrated cardiac magnetic resonance imaging with coronary magnetic resonance angiography, stress-perfusion, and delayed-enhancement imaging for the detection of occult coronary artery disease in asymptomatic individuals. Int J Cardiovasc Imaging 2015; 31 Suppl 1:77-89. [DOI: 10.1007/s10554-015-0665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
|
|
45
|
A novel coronary angiography index (DILEMMA score) for prediction of functionally significant coronary artery stenoses assessed by fractional flow reserve: A novel coronary angiography index. Am Heart J 2015; 169:564-71.e4. [PMID: 25819864 DOI: 10.1016/j.ahj.2014.11.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/03/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Angiographic evaluation of diameter stenosis has modest predictive value for functionally significant coronary artery stenoses as assessed by fractional flow reserve (FFR). Lesion length and assessment of area of myocardium at risk (Bypass Angioplasty Revascularization Investigation [BARI] Myocardial Jeopardy Index [MJI]) subtended by the stenotic coronary arteries are also predictors of functionally significant coronary artery stenoses. We sort to assess the diagnostic accuracy of DILEMMA score, which combines minimal lumen diameter (MLD), lesion length, and BARI MJI in prediction of significantly reduced FFR (≤0.8). METHODS We assessed patients who underwent coronary angiography and FFR. Lesion length and MLD were assessed by quantitative coronary angiography. Estimation of area of myocardium at risk subtended by coronary stenoses was performed using the BARI MJI. RESULTS A total of 296 patients (age 64 ± 10.6 years, 68% male, 497 vessels) were included. DILEMMA score was significantly higher in vessels with significant FFR, 6.09 ± 3.23 versus 3.84 ± 2.99 (P < .001). In the derivation cohort, the optimism-adjusted Harrell c statistic for DILEMMA score was 0.82 compared with 0.76 for BARI MJI, 0.75 for lesion length, and 0.7 for MLD. In the validation cohort, the c-statistic for DILEMMA score, BARI MJI, lesion length, and MLD was 0.88, 0.77, 0.81, and 0.72, respectively. The DILEMMA score was a better predictor of FFR ≤0.8 compared with MLD, lesion length, and BARI MJI individually (P < .001, P < .02, and P < .045, respectively) on Bonferroni-adjusted pairwise comparison. CONCLUSIONS DILEMMA score, taking into account MLD, lesion length, and BARI MJI, may have incremental predictive value beyond the individual indices alone for detecting functionally significant coronary artery stenoses.
Collapse
|
|
46
|
Abstract
Coronary artery disease is the most common cause of mortality and morbidity around the globe. Assessment of myocardial perfusion to diagnose ischemia is commonly performed in symptomatic patients prior to referral for cardiac catheterization. Among other noninvasive imaging modalities, cardiac MRI (CMR) is emerging as a highly sensitive and specific test for myocardial ischemia and infarction. Resting perfusion on CMR is used to evaluate for microvascular obstruction, which is shown to predict adverse left ventricular remodeling and cardiac events after acute myocardial infarction. This article summarizes the current understanding of CMR perfusion.
Collapse
Affiliation(s)
- Yasmin S Hamirani
- Division of Cardiology, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA
| | | |
Collapse
|
|
47
|
Ko SM, Hwang HK, Kim SM, Cho IH. Multi-modality imaging for the assessment of myocardial perfusion with emphasis on stress perfusion CT and MR imaging. Int J Cardiovasc Imaging 2015; 31 Suppl 1:1-21. [PMID: 25809387 DOI: 10.1007/s10554-015-0645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
High-quality and non-invasive diagnostic tools for assessing myocardial ischemia are necessary for therapeutic decisions regarding coronary artery disease. Myocardial perfusion has been studied using myocardial contrast echo perfusion, single-photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and, more recently, computed tomography. The addition of coronary computed tomography angiography to myocardial perfusion imaging improves the specificity and overall diagnostic accuracy of detecting the hemodynamic significance of coronary artery stenosis. This study reviews the benefits, limitations, and imaging findings of various imaging modalities for assessing myocardial perfusion, with particular emphasis on stress perfusion computed tomography and cardiovascular magnetic resonance imaging.
Collapse
Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea,
| | | | | | | |
Collapse
|
|
48
|
Heydari B, Kwong RY, Jerosch-Herold M. Technical advances and clinical applications of quantitative myocardial blood flow imaging with cardiac MRI. Prog Cardiovasc Dis 2015; 57:615-22. [PMID: 25727176 DOI: 10.1016/j.pcad.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The recent FAME 2 study highlights the importance of myocardial ischemia assessment, particularly in the post-COURAGE trial era of managing patients with stable coronary artery disease. Qualitative assessment of myocardial ischemia by stress cardiovascular magnetic resonance imaging (CMR) has gained widespread clinical acceptance and utility. Despite the high diagnostic and prognostic performance of qualitative stress CMR, the ability to quantitatively assess myocardial perfusion reserve and absolute myocardial blood flow remains an important and ambitious goal for non-invasive imagers. Quantitative perfusion by stress CMR remains a research technique that has yielded progressively more encouraging results in more recent years. The ability to safely, rapidly, and precisely procure quantitative myocardial perfusion data would provide clinicians with a powerful tool that may substantially alter clinical practice and improve downstream patient outcomes and the cost effectiveness of healthcare delivery. This may also provide a surrogate endpoint for clinical trials, reducing study population sizes and costs through increased power. This review will cover emerging quantitative CMR techniques for myocardial perfusion assessment by CMR, including novel methods, such as 3-dimensional quantitative myocardial perfusion, and some of the challenges that remain before more widespread clinical adoption of these techniques may take place.
Collapse
Affiliation(s)
- Bobak Heydari
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115
| | - Michael Jerosch-Herold
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115.
| |
Collapse
|
|
49
|
Ko BS, Wong DTL, Cameron JD, Leong DP, Soh S, Nerlekar N, Meredith IT, Seneviratne SK. The ASLA Score: A CT Angiographic Index to Predict Functionally Significant Coronary Stenoses in Lesions with Intermediate Severity-Diagnostic Accuracy. Radiology 2015; 276:91-101. [PMID: 25710278 DOI: 10.1148/radiol.15141231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To identify computed tomographic (CT) coronary indexes independently associated with a fractional flow reserve (FFR) of 0.8 or less, to derive a score that combines CT indexes most predictive of an FFR of 0.8 or less, and to evaluate the diagnostic accuracy of the score in predicting an FFR of 0.8 or less. MATERIALS AND METHODS This retrospective study had institutional review board approval and waiver of the need to obtain informed consent. Consecutive patients who underwent CT coronary angiography and FFR assessment with one or more discrete lesion(s) of intermediate (30%-70%) severity at CT were included. Quantitative CT measurements were performed by using dedicated software. The CT indexes evaluated included the following: plaque burden, minimal luminal area and diameter, stenosis diameter, area of stenosis, lesion length, remodeling index, plaque morphology, calcification severity, and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score, which approximates the size of the myocardium subtended by a lesion. By using covariates independently associated with an FFR of 0.8 or less, a score was determined on the basis of modified Akaike information criteria, and the C statistics of individual and combined indexes were compared. RESULTS Eighty-five patients (mean age, 64.2 years; range, 48-88 years; 65.9% men; 124 lesions; 38 lesions with an FFR ≤ 0.8) were included. Area of stenosis, lesion length, and APPROACH score were the strongest predictors of an FFR of 0.8 or less and were used to derive the ASLA score. The optimism-adjusted Harrell C statistic for the combined score was 0.82, which was superior to that for area of stenosis (0.74), lesion length (0.75), and the APPROACH score (0.71) (P < .001 for trend). The corresponding incremental discrimination improvement indexes were 0.17, 0.11, and 0.19, respectively (P < .001 for all), suggesting that the score improves reclassification compared with any one angiographic index. The average time required for score derivation was 102.6 seconds. CONCLUSION The ASLA score, which accounts for CT-derived area of stenosis, lesion length, and APPROACH score, may conveniently improve the prediction, beyond individual indexes, of functionally significant intermediate coronary lesions.
Collapse
Affiliation(s)
- Brian S Ko
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Dennis T L Wong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - James D Cameron
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Darryl P Leong
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Siang Soh
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Ian T Meredith
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| | - Sujith K Seneviratne
- From the Monash Cardiovascular Research Centre, Department of Medicine (Monash Medical Centre), Monash University and Monash Heart, Monash Health, 246 Clayton Road, Clayton, 3168 VIC, Australia (B.S.K., D.T.L.W., J.D.C., S.S., N.N., I.T.M., S.K.S.); Discipline of Medicine, University of Adelaide, Adelaide, Australia (D.T.L.W., D.P.L.); and Discipline of Medicine, Flinders University, Adelaide, Australia (D.P.L.)
| |
Collapse
|
|
50
|
Functional relevance of coronary artery disease by cardiac magnetic resonance and cardiac computed tomography: myocardial perfusion and fractional flow reserve. BIOMED RESEARCH INTERNATIONAL 2015; 2015:297696. [PMID: 25692133 PMCID: PMC4323071 DOI: 10.1155/2015/297696] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/31/2014] [Indexed: 01/17/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.
Collapse
|