Quantitative three-dimensional cardiovascular magnetic resonance myocardial perfusion imaging in systole and diastole.
Quantitative three-dimensional cardiovascular magnetic resonance myocardial perfusion imaging in systole and diastole.
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DOI：
10.1186/1532-429x-16-19
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发表时间：
2014-02-24
期刊：
影响因子：
--
通讯作者：
Plein S
中科院分区：
文献类型：
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作者：
Motwani M;Kidambi A;Sourbron S;Fairbairn TA;Uddin A;Kozerke S;Greenwood JP;Plein S
二维 (2D) 灌注心血管磁共振 (CMR) 仍然因缺乏完整的心肌覆盖而受到限制。三维 (3D) 灌注 CMR 解决了这一局限性，并且最近已被证明在临床上是可行的。然而，正如 2D 灌注 CMR 和正电子发射断层扫描所显示的那样，定量 3D 灌注测量的可行性和潜在临床实用性尚未得到评估。对于 3D 灌注 CMR，收缩期或舒张期采集对心肌血流量 (MBF) 估计、诊断准确性和图像质量的影响也是未知的。本研究的目的是确定定量 3D 灌注 CMR 用于检测冠状动脉疾病 (CAD) 的可行性，并比较 MBF 的收缩压和舒张压估计值。 35 名患者接受了 3D 灌注 CMR，并在收缩末期和舒张中期采集了数据。 MBF 和心肌灌注储备 (MPR) 通过费米约束解卷积按每个患者和每个区域进行估计。显着 CAD 定义为定量冠状动脉造影中狭窄≥70%。 20 名患者患有严重的 CAD（涉及 105 个地区中的 38 个地区）。压力 MBF 和 MPR 对收缩期（曲线下面积 [AUC]：分别为 0.95 和 0.92）和舒张期（AUC：0.95 和 0.94）检测 CAD 具有较高的诊断准确性。收缩期和舒张期的 AUC 没有显着差异（p 值 >0.05）。在应激状态下，舒张期 MBF 估计值显着高于收缩期估计值（无 CAD：3.21±0.50 vs. 2.75±±0.42 ml/g/min，p<0.0001；CAD：2.13±0.45 vs. 1.98 ±0.41毫升/克/分钟，p< 0.0001)；但在休息时，没有显着差异（p 值>0.05）。收缩期的图像质量高于舒张期的图像质量（中位数得分 3 比 2，p = 0.002）。定量 3D 灌注 CMR 是可行的。对于应激时的收缩期和舒张期，MBF 估计值显着不同，但两个心动时相检测 CAD 的诊断准确性都很高。更好的图像质量表明收缩期数据采集可能更可取。
Two-dimensional (2D) perfusion cardiovascular magnetic resonance (CMR) remains limited by a lack of complete myocardial coverage. Three-dimensional (3D) perfusion CMR addresses this limitation and has recently been shown to be clinically feasible. However, the feasibility and potential clinical utility of quantitative 3D perfusion measurements, as already shown with 2D-perfusion CMR and positron emission tomography, has yet to be evaluated. The influence of systolic or diastolic acquisition on myocardial blood flow (MBF) estimates, diagnostic accuracy and image quality is also unknown for 3D-perfusion CMR. The purpose of this study was to establish the feasibility of quantitative 3D-perfusion CMR for the detection of coronary artery disease (CAD) and to compare systolic and diastolic estimates of MBF. Thirty-five patients underwent 3D-perfusion CMR with data acquired at both end-systole and mid-diastole. MBF and myocardial perfusion reserve (MPR) were estimated on a per patient and per territory basis by Fermi-constrained deconvolution. Significant CAD was defined as stenosis ≥70% on quantitative coronary angiography. Twenty patients had significant CAD (involving 38 out of 105 territories). Stress MBF and MPR had a high diagnostic accuracy for the detection of CAD in both systole (area under curve [AUC]: 0.95 and 0.92, respectively) and diastole (AUC: 0.95 and 0.94). There were no significant differences in the AUCs between systole and diastole (p values >0.05). At stress, diastolic MBF estimates were significantly greater than systolic estimates (no CAD: 3.21 ± 0.50 vs. 2.75 ± 0.42 ml/g/min, p < 0.0001; CAD: 2.13 ± 0.45 vs. 1.98 ± 0.41 ml/g/min, p < 0.0001); but at rest, there were no significant differences (p values >0.05). Image quality was higher in systole than diastole (median score 3 vs. 2, p = 0.002). Quantitative 3D-perfusion CMR is feasible. Estimates of MBF are significantly different for systole and diastole at stress but diagnostic accuracy to detect CAD is high for both cardiac phases. Better image quality suggests that systolic data acquisition may be preferable.