Masaki Ishida MD,PhD, Presenter: Nothing to Disclose

Mio Uno MD, Abstract Co-Author: Nothing to Disclose

Ryohei Nakayama PhD, Abstract Co-Author: Nothing to Disclose

Yoshitaka Goto MD, Abstract Co-Author: Nothing to Disclose

Tatsuro Ito MD, Abstract Co-Author: Nothing to Disclose

Motonori Nagata MD, PhD, Abstract Co-Author: Nothing to Disclose

Yasutaka Ichikawa MD, Abstract Co-Author: Nothing to Disclose

Kaoru Dohi, Abstract Co-Author: Nothing to Disclose

Kakuya Kitagawa MD, PhD, Abstract Co-Author: Nothing to Disclose

Hajime Sakuma MD, Abstract Co-Author: Research Grant, Siemens AG Research Grant, Koninklijke Philips NV Research Grant, General Electric Company Research Grant, Bayer AG Research Grant, Guerbet SA

Stress cardiac MR study including stress perfusion and late gadolinium enhanced (LGE) MRI provide accurate detection of myocardial ischemia and infarction, while coronary MRA allows for morphological assessment of luminal narrowing in coronary artery disease (CAD). However, additive diagnostic value of coronary MRA in stress cardiac MR study in not well known. The purpose of this study was to evaluate if addition of coronary MRA can improve the diagnostic performance of stress cardiac MR study in detecting significant CAD.

We prospectively studied 87 patients with suspected CAD (age, 69±11 years) who were scheduled catheter coronary angiography (CAG). Patients underwent cardiac MRI including stress perfusion MRI, LGE MRI and coronary MRA suing 1.5T MR imager and 32 channel coils. Two observers assessed stress perfusion MRI and coronary MRA separately using 4-point scale in each coronary territory. Stress-induced hypo-perfusion observed in the absence of LGE was considered abnormal on perfusion MR images. Consensus binary reading by two observers was performed separately. Luminal narrowing of >50% was considered to be significant on CAG.   

On vessel-based analysis in all 261 coronary arteries, the areas under ROC (AUC) of stress perfusion MRI was 0.759 for observer 1 and 0.761 for observer 2. These AUCs were significantly improved by adding coronary MRA (0.861 for observer 1, p=0.001 and 0.831 for observer 2, p=0.019). The sensitivity and specificity on patient-based analysis for predicting significant CAD were 78% and 66% by stress perfusion MRI alone and 90% and 79% by side-by-side assessment of stress perfusion MRI and coronary MRA. In 227(87%) coronary arteries without previous stent implantation, the sensitivity and specificity on vessel-based analysis for detecting significant CAD were 33% and 91% by LGE MRI, 76% and 88% by stress perfusion MRI, 89% and 89% by coronary MRA and 93% and 89% by combined assessment of stress perfusion MRI and coronary MRA, respectively.  

The results in this study demonstrate that addition of coronary MRA in stress cardiac MR study can provide excellent diagnostic performance for the detection of CAD.

Performing coronary MRA in a comprehensive stress cardiac MR protocol is highly valuable for more accurate detection of coronary artery disease.

Ishida, M, Uno, M, Nakayama, R, Goto, Y, Ito, T, Nagata, M, Ichikawa, Y, Dohi, K, Kitagawa, K, Sakuma, H, Additive Diagnostic Value of Coronary MRA in the Stress Cardiac MR Protocol Including Stress Myocardial Perfusion MRI and Late Gadolinium Enhanced MRI for the Detection of Coronary Artery Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045654.html