Adenosine Stress Cardiovascular Magnetic Resonance With Variable Density Spiral Pulse Sequences Accurately Detects Coronary Artery Disease: Initial Clinical Evaluation
Background—Adenosine stress CMR perfusion imaging can be limited by motion-induced dark-rim artifacts (DRA), which may be mistaken for true perfusion abnormalities. A high-resolution variable-density spiral (VDS) pulse sequence with a novel density compensation strategy has been shown to reduce DRA in first-pass perfusion imaging. We aimed to assess the clinical performance of adenosine stress CMR using this new perfusion sequence to detect obstructive coronary artery disease (CAD).
Methods and Results—CMR perfusion imaging was performed during adenosine stress (140µg/kg-min) and at rest on a Siemens 1.5T Avanto scanner in 41 subjects with chest pain scheduled for coronary angiography (CA). Perfusion images were acquired during injection of 0.1mmol/kg Gd-DTPA at 3 short-axis locations using a saturation recovery (SR) interleaved VDS pulse sequence. Significant stenosis was defined as >50% by quantitative CA (QCA). Two blinded reviewers evaluated the perfusion images for the presence of adenosine-induced perfusion abnormalities and assessed image quality using a 5 point scale (1 - poor to 5- excellent). The prevalence of obstructive CAD by QCA was 68%. The average sensitivity, specificity, and accuracy were 89%, 85%, and 88% respectively with a positive predictive value and negative predictive value of 93% and 79% respectively. The average image quality score was 4.4±0.7 with only one study with more than mild DRA. There was good inter-reader reliability with a kappa statistic of 0.67.
Conclusions—Spiral adenosine stress CMR results in high diagnostic accuracy for the detection of obstructive CAD with excellent image quality and minimal DRA.
- Received December 23, 2013.
- Accepted April 7, 2014.