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Dark-rim-free ungated first-pass perfusion CMR with 3-Slice end-systolic imaging: initial experience

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The latter can be challenging in the presence of arrhythmias or heart-rate variations during stress... Moreover, end-systolic (ES) imaging has recently been shown to provide improved visualization of subendocardial defects... We hypothesized that the developed method achieves DRA-free imaging and high accuracy in patients with suspected CAD, using nuclear myocardial perfusion imaging (MPI) as the reference... Based on the so-called "Ungated Cine FPP" approach, a multi-slice magnetization-driven method was developed for ungated FPP imaging... Figure 1 highlights the main differences of the proposed pulse sequence compared with the conventional FPP method... Patients (n = 9) with suspected CAD on the basis of recent abnormal SPECT/PET MPI underwent adenosine stress/rest FFP CMR... Stress-induced hypoperfusion was observed in the ES Ungated Cine FPP images, corresponding to a reversible defect on PET MPI (Figure 2b)... However, for the 3 studies using the conventional method, mild-moderate DRA was observed in 21% of the segments... Conventional FPP methods are prone to DRAs, require accurate ECG gating, and do not provide the freedom to image all slices at ES... The developed method overcomes these challenges and is an attractive alternative with the advantage of simplicity (no gating), higher accuracy in the subendocardium (no DRAs, ES imaging), and thereby potentially improved reliability... Preliminary results in healthy volunteers and patients with suspected CAD were of high quality and showed high accuracy compared to nuclear MPI.

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Representative images from the CAD patient study (top row: vasodilator stress; bottom row: rest, yellow arrows point to perfusion defects). (a) End-systolic 3-slice images for the proposed Ungateed Cine FPP method (1.7 × 1.7 mm2 in-plane resolution). (b) Corresponding PET myocardial perfusion slices (mild ischemia qith 6% stress-induced defect in the anter-lateral wall at mild-basal slices). (c) Conventional ECG-gateed SR-prepared FPP images (red arrow points to dark-rim artifact). The Ungated Cine FPP images are in strong agreement with the PET study and have higher quality than conventional FPP.
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Figure 2: Representative images from the CAD patient study (top row: vasodilator stress; bottom row: rest, yellow arrows point to perfusion defects). (a) End-systolic 3-slice images for the proposed Ungateed Cine FPP method (1.7 × 1.7 mm2 in-plane resolution). (b) Corresponding PET myocardial perfusion slices (mild ischemia qith 6% stress-induced defect in the anter-lateral wall at mild-basal slices). (c) Conventional ECG-gateed SR-prepared FPP images (red arrow points to dark-rim artifact). The Ungated Cine FPP images are in strong agreement with the PET study and have higher quality than conventional FPP.

Mentions: The ungated FPP studies in normal subjects were all of high quality and demonstrated normal perfusion. A representative patient study is shown in Figure 2. Stress-induced hypoperfusion was observed in the ES Ungated Cine FPP images, corresponding to a reversible defect on PET MPI (Figure 2b). Figure 2c shows the mid slice for the conventional FPP scan. Based on nuclear MPI studies, sensitivity and specificity of the developed method were 93% and 95%, respectively. The minor disagreements can be explained by the presence of subendocardial defects and possible artifacts on SPECT. All images were reviewed and no DRAs was detected on the Ungated Cine FPP images (2 readers, consensus). However, for the 3 studies using the conventional method, mild-moderate DRA was observed in 21% of the segments.


Dark-rim-free ungated first-pass perfusion CMR with 3-Slice end-systolic imaging: initial experience
Representative images from the CAD patient study (top row: vasodilator stress; bottom row: rest, yellow arrows point to perfusion defects). (a) End-systolic 3-slice images for the proposed Ungateed Cine FPP method (1.7 × 1.7 mm2 in-plane resolution). (b) Corresponding PET myocardial perfusion slices (mild ischemia qith 6% stress-induced defect in the anter-lateral wall at mild-basal slices). (c) Conventional ECG-gateed SR-prepared FPP images (red arrow points to dark-rim artifact). The Ungated Cine FPP images are in strong agreement with the PET study and have higher quality than conventional FPP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4044118&req=5

Figure 2: Representative images from the CAD patient study (top row: vasodilator stress; bottom row: rest, yellow arrows point to perfusion defects). (a) End-systolic 3-slice images for the proposed Ungateed Cine FPP method (1.7 × 1.7 mm2 in-plane resolution). (b) Corresponding PET myocardial perfusion slices (mild ischemia qith 6% stress-induced defect in the anter-lateral wall at mild-basal slices). (c) Conventional ECG-gateed SR-prepared FPP images (red arrow points to dark-rim artifact). The Ungated Cine FPP images are in strong agreement with the PET study and have higher quality than conventional FPP.
Mentions: The ungated FPP studies in normal subjects were all of high quality and demonstrated normal perfusion. A representative patient study is shown in Figure 2. Stress-induced hypoperfusion was observed in the ES Ungated Cine FPP images, corresponding to a reversible defect on PET MPI (Figure 2b). Figure 2c shows the mid slice for the conventional FPP scan. Based on nuclear MPI studies, sensitivity and specificity of the developed method were 93% and 95%, respectively. The minor disagreements can be explained by the presence of subendocardial defects and possible artifacts on SPECT. All images were reviewed and no DRAs was detected on the Ungated Cine FPP images (2 readers, consensus). However, for the 3 studies using the conventional method, mild-moderate DRA was observed in 21% of the segments.

View Article: PubMed Central - HTML

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The latter can be challenging in the presence of arrhythmias or heart-rate variations during stress... Moreover, end-systolic (ES) imaging has recently been shown to provide improved visualization of subendocardial defects... We hypothesized that the developed method achieves DRA-free imaging and high accuracy in patients with suspected CAD, using nuclear myocardial perfusion imaging (MPI) as the reference... Based on the so-called "Ungated Cine FPP" approach, a multi-slice magnetization-driven method was developed for ungated FPP imaging... Figure 1 highlights the main differences of the proposed pulse sequence compared with the conventional FPP method... Patients (n = 9) with suspected CAD on the basis of recent abnormal SPECT/PET MPI underwent adenosine stress/rest FFP CMR... Stress-induced hypoperfusion was observed in the ES Ungated Cine FPP images, corresponding to a reversible defect on PET MPI (Figure 2b)... However, for the 3 studies using the conventional method, mild-moderate DRA was observed in 21% of the segments... Conventional FPP methods are prone to DRAs, require accurate ECG gating, and do not provide the freedom to image all slices at ES... The developed method overcomes these challenges and is an attractive alternative with the advantage of simplicity (no gating), higher accuracy in the subendocardium (no DRAs, ES imaging), and thereby potentially improved reliability... Preliminary results in healthy volunteers and patients with suspected CAD were of high quality and showed high accuracy compared to nuclear MPI.

No MeSH data available.


Related in: MedlinePlus