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(Circulation. 2004;110:58-65.)
© 2004 American Heart Association, Inc.

Original Articles

Magnetic Resonance Versus Radionuclide Pharmacological Stress Perfusion Imaging for Flow-Limiting Stenoses of Varying Severity

Daniel C. Lee, MD; Orlando P. Simonetti, PhD; Kathleen R. Harris, BA; Thomas A. Holly, MD; Robert M. Judd, PhD; Edwin Wu, MD; Francis J. Klocke, MD

From the Feinberg Cardiovascular Research Institute (D.C.L., K.R.H., T.A.H., R.M.J., E.W., F.J.K.) and Departments of Medicine (D.C.L., T.A.H., R.M.J., E.W., F.J.K.) and Biomedical Engineering (R.M.J., F.J.K.), The Feinberg School of Medicine, Northwestern University, and Siemens Medical Solutions (O.P.S.), Chicago, Ill. Dr Judd is presently at the Duke University Medical Center, Durham, NC.

Correspondence to Francis J. Klocke, MD, Feinberg Cardiovascular Research Institute (T233), 303 East Chicago Ave, Chicago, IL 60611. E-mail f-klocke{at}northwestern.edu

Received June 30, 2003; de novo received January 29, 2004; revision received March 17, 2004; accepted March 22, 2004.

Background— Although magnetic resonance first-pass imaging (MRFP) has potential advantages in pharmacological stress perfusion imaging, direct comparisons of current MRFP and established radionuclide techniques are not available.

Methods and Results— Graded regional differences in coronary flow were produced during global coronary vasodilation in chronically instrumented dogs by partially occluding the left circumflex artery. Regional differences in full-thickness flow quantified using microspheres were compared with regional differences obtained with MRFP and radionuclide SPECT imaging (^99mTc-sestamibi and ²⁰¹Tl). Relative regional flows (RRFs) derived from the initial areas under MRFP signal intensity-time curves were linearly related to reference microsphere RRFs over the full range of vasodilation (y=0.93x+4.3; r²=0.77). Relationships between ^99mTc-sestamibi and ²⁰¹Tl RRFs and microsphere RRFs were curvilinear, plateauing as flows increased. The high spatial resolution of the MRI enabled transmural flow to be evaluated in 3 to 5 layers across the myocardial wall. Reductions in subendocardial flow were visually apparent in MRFP images for 50% reductions in full-thickness flow. Endocardial-to-epicardial gradients in MRFP flow increased progressively with stenosis severity, whereas transmural flow patterns in remote normally perfused myocardium remained normal. Flow reductions of 50% not identified by radionuclide imaging were apparent in MRFP full-thickness and transmural analyses.

Conclusions— High-resolution MRFP can identify regional reductions in full-thickness myocardial blood flow during global coronary vasodilation over a wider range than current SPECT imaging. Transmural flow gradients can also be identified; their magnitude increases progressively as flow limitations become more severe and endocardial flow is compromised increasingly.

Key Words: magnetic resonance imaging • scintigraphy • regional blood flow • vasodilation

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