Value of additional myocardial perfusion imaging during dobutamine stress magnetic resonance for the assessment of intermediate coronary artery disease

Int J Cardiovasc Imaging. 2012 Jan;28(1):89-97. doi: 10.1007/s10554-010-9764-3. Epub 2010 Dec 14.

Abstract

This study was performed to assess the role of additional myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR-wall motion) for the evaluation of patients with intermediate (50-70%) coronary artery stenosis. Routine DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 174 consecutive patients with chest pain syndromes who were scheduled for a clinically indicated coronary angiography. When defining CAD as the presence of a ≥ 50% stenosis, the addition of perfusion imaging improved sensitivity (90 vs. 79%, P < 0.001) with a non-significant reduction in specificity (85 vs. 90%, P = 0.13) and an improvement in overall diagnostic accuracy (88 vs. 84%, P = 0.008). Adding perfusion imaging improved sensitivity in patients with intermediate stenosis (87 vs. 72%, P = 0.03), but not in patients with severe (≥70%) stenosis (93 vs. 84%, P = 0.06). In patients with severe stenosis specificity of DSMR-perfusion versus DSMR-wall motion decreased (61 vs 70%, P = 0.001) resulting in a lower overall accuracy (71 vs 74%, P = 0.03). Using a cutoff of ≥50% for the definition of CAD, sensitivity of DSMR-perfusion compared to DSMR-wall motion was significantly higher in patients with single vessel (88 vs. 77%, P = 0.03) and multi vessel disease (93 vs. 79%, P = 0.03), whereas no significant differences were found using a cutoff of ≥70% stenosis for the definition of CAD. The addition of perfusion imaging during DSMR-wall motion improved the sensitivity in patients with intermediate coronary artery stenosis. Overall diagnostic accuracy increased only when defining CAD as ≥50% stenosis. In patients with ≥70% stenosis DSMR-wall motion alone had higher accuracy due to more false-positive cases with DSMR-perfusion.

MeSH terms

  • Aged
  • Analysis of Variance
  • Chest Pain / complications
  • Contrast Media
  • Coronary Angiography / methods
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / pathology*
  • Coronary Stenosis / complications
  • Coronary Stenosis / pathology
  • Dobutamine*
  • Female
  • Gadolinium DTPA
  • Humans
  • Image Enhancement / methods
  • Magnetic Resonance Angiography / methods*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • Dobutamine
  • Gadolinium DTPA