American Journal of Roentgenology, Vol 161, 257-263, Copyright © 1993 by American Roentgen Ray Society

ARTICLES

Detection of chronic coronary artery disease: value of pharmacologically stressed, dynamically enhanced turbo-fast low-angle shot MR images

MA Klein, BD Collier, RS Hellman and VS Bamrah
Department of Radiology, Medical College of Wisconsin, Milwaukee.

OBJECTIVE. The potential of MR imaging for evaluating myocardial perfusion and viability may make it the imaging procedure of choice for examining patients with ischemic heart disease. Accordingly, the purpose of this study is to determine the value of pharmacologically stressed, dynamically enhanced turbo-fast low-angle shot (FLASH) MR imaging in detecting chronic coronary artery disease. SUBJECTS AND METHODS. Five patients who had coronary angiography within the past 6- 12 months were included in the study. After injection of 0.56 mg/kg of dipyridamole over 4 min, a bolus of 0.05 mg/kg of gadopentetate dimeglumine and subsequently 10 mCi (370 MBq) of 99mTc-sestamibi were injected. Short-axis turbo-FLASH images were obtained before injection and immediately, 1 min, 3 min, and 5 min after the injection of contrast material. Stress single-photon emission computed tomography (SPECT) images of the heart were obtained 60 min after the 99mTc- sestamibi injection. One and a half hours after an additional 30 mCi (1110 MBq) of 99mTc-sestamibi was injected, SPECT images were obtained with patients at rest. Prospective MR imaging evaluation of these five patients was performed by radiologists who did not know any of the imaging data. The MR imaging studies were compared with the near simultaneous 99mTc-sestamibi SPECT studies and with recent coronary angiograms. RESULTS. Thirteen myocardial segments were diagnosed as abnormal when 99mTc-sestamibi SPECT was used as the gold standard (12 reversible defects and one fixed defect). Twelve segments were normal on the 99mTc-sestamibi SPECT study. With SPECT as the gold standard, prospective MR imaging had a sensitivity of 77% and a specificity of 75%, whereas retrospectively it had a sensitivity of 92% and a specificity of 75%. With recent coronary angiography as the gold standard, prospective MR imaging had a sensitivity of 81% and a specificity of 100%. The quantitative data did not improve the accuracy of the qualitative analysis. CONCLUSION. Our results suggest that accurate prospective identification of chronic coronary artery disease may be possible with dynamically enhanced, pharmacologically stressed, turbo-FLASH MR imaging. Studies of additional patients to confirm this initial impression are warranted.
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