Ischemic Burden by Three-dimensional Myocardial Perfusion Cardiovascular Magnetic Resonance: Comparison with Myocardial Perfusion Scintigraphy
Background—The extent and severity of ischemia on myocardial perfusion scintigraphy (MPS) is commonly used to risk-stratify patients with coronary artery disease (CAD). Estimation of ischemic burden by cardiovascular magnetic resonance (CMR) with conventional two-dimensional myocardial perfusion methods is limited by incomplete cardiac coverage. More recently developed three-dimensional (3D) myocardial perfusion CMR however provides whole heart coverage. The aim of this study was to compare ischemic burden on 3D myocardial perfusion CMR with 99mTc-tetrofosmin MPS.
Methods and Results—Forty-five patients who had undergone clinically indicated MPS underwent rest and adenosine stress 3D myocardial perfusion and late gadolinium enhancement CMR. Summed stress and rest scores were calculated for MPS and CMR using a 17-segment model and expressed as a percentage of the maximal possible score. Ischemic burden was defined as the difference between stress and rest scores. 3D myocardial perfusion CMR and MPS agreed in 38 of the 45 patients for the detection of any inducible ischemia. The mean ischemic burden for MPS and CMR was similar (7.5+/-8.9% versus 6.8+/-9.5%, respectively, P=0.82) with a strong correlation between techniques (rs=0.70, P<0.001). In a subset of 33 patients who underwent clinically indicated invasive coronary angiography, sensitivities and specificities of the two techniques to detect angiographic CAD were similar (McNemar P=0.45).
Conclusions—3D myocardial perfusion CMR is an alternative to MPS for detecting the presence and rating the severity of ischemia with the added benefits of higher spatial resolution and no exposure to ionizing radiation.
- cardiovascular magnetic resonance imaging
- myocardial perfusion scintigraphy
- single-photon emission computed tomography
- myocardial perfusion
- Received September 4, 2013.
- Accepted May 16, 2014.