Circulation, Vol 90, 127-138, Copyright © 1994 by American Heart Association
FP van Rugge, EE van der Wall, SJ Spanjersberg, A de Roos, NA Matheijssen, AH Zwinderman, PR van Dijkman, JH Reiber and AV Bruschke
BACKGROUND: Quantitative measurement of wall motion is essential to assess
objectively the functional significance of coronary artery disease. We
developed a quantitative wall thickening analysis on stress magnetic
resonance images. This study was designed to assess the clinical value of
magnetic resonance imaging (MRI) during dobutamine stress for detection and
localization of myocardial ischemia in patients with suspected coronary
artery disease. METHODS AND RESULTS: Thirty-nine consecutive patients with
clinically suspected coronary artery disease referred for coronary
arteriography and 10 normal volunteers underwent gradient-echo MRI at rest
and during peak dobutamine stress (infusion rate, 20
micrograms.kg-1.min-1). MRI was performed in the short-axis plane at four
adjacent levels. Display in a cine loop provided a qualitative impression
of regional wall motion (cine MRI). A modification of the centerline method
was applied for quantitative wall motion analysis by means of calculation
of percent systolic wall thickening. Short-axis cine MRI images were
analyzed at 100 equally spaced chords constructed perpendicular to a
centerline drawn midway between the end-diastolic and end-systolic
contours. Dobutamine MRI was considered positive for coronary artery
disease if the percent systolic wall thickening of more than four adjacent
chords was < 2 SD below the mean values obtained from the normal
volunteers. The overall sensitivity of dobutamine MRI for the detection of
significant coronary artery disease (diameter stenosis > or = 50%) was
91% (30 of 33), specificity was 80% (5 of 6), and accuracy was 90% (35 of
39). The sensitivity for identifying one-vessel disease was 88% (15 of 17),
for two-vessel disease 91% (10 of 11), and for three-vessel disease 100% (5
of 5). The sensitivity for detection of individual coronary artery lesions
was 75% for the left anterior descending coronary artery, 87% for the right
coronary artery, and 63% for the left circumflex coronary artery.
CONCLUSIONS: Dobutamine MRI clearly identifies wall motion abnormalities by
quantitative analysis using a modification of the centerline method.
Dobutamine MRI is an accurate method for detection and localization of
myocardial ischemia and may emerge as a new noninvasive approach for
evaluation of patients with known or suspected coronary artery disease.
ARTICLES
Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease. Quantitative wall motion analysis using a modification of the centerline method
Department of Cardiology, University Hospital, Leiden, The Netherlands.
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