Published online before print August 2, 2004, doi: 10.1161/01.CIR.0000138106.84335.62
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(Circulation. 2004;110:732-737.)
© 2004 American Heart Association, Inc.
Original Articles |
Myocardial First-Pass Perfusion Magnetic Resonance Imaging
A Multicenter Dose-Ranging Study
From the Cardiovascular Research Foundation and Lenox Hill Hospital, New York, NY (S.D.W., A.J.L., C.R.C.); University Hospital of Zurich, Zurich, Switzerland (J.S.); Papworth and Addenbrooke’s Hospitals, Cambridge, UK (R.C.); Franz-Volhard Klinik, Berlin-Buch, Germany (M.G.F.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (D.A.B.); Allegheny General Hospital, Pittsburgh, Pa (R.W.B.); Oklahoma Heart Institute, Tulsa (E.T.M.); Berlex Laboratories, Montville, NJ (F.K.); and GE Medical Systems, Milwaukee, Wis (T.K.F.F., P.E.L.).
Correspondence to Steven D. Wolff, MD, PhD, Director of Cardiovascular MRI, Advanced Cardiovascular Imaging, 62 E 88th St, Lower Level, New York, NY 10128, E-mail swolff{at}mrict.com
Received December 29, 2003; revision received March 10, 2004; accepted March 17, 2004.
Background— MRI can identify patients with obstructive coronary artery disease by imaging the left ventricular myocardium during a first-pass contrast bolus in the presence and absence of pharmacologically induced myocardial hyperemia. The purpose of this multicenter dose-ranging study was to determine the minimally efficacious dose of gadopentetate dimeglumine injection (Magnevist Injection; Berlex Laboratories) for detecting obstructive coronary artery disease.
Method and Results— A total of 99 patients scheduled for coronary artery catheterization as part of their clinical evaluation were enrolled in this study. Patients were randomized to 1 of 3 doses of gadopentate dimeglumine: 0.05, 0.10, or 0.15 mmol/kg. First-pass perfusion imaging was performed during hyperemia (induced by a 4-minute infusion of adenosine at a rate of 140 µg · kg–1 · min–1) and then again in the absence of adenosine with otherwise identical imaging parameters and the same contrast dose. Perfusion defects were evaluated subjectively by 4 blinded reviewers. Receiver-operating curve analysis showed that the areas under the receiver-operating curve were 0.90, 0.72, and 0.83 for the low-, medium-, and high-contrast doses, respectively, compared with quantitative coronary angiography (diameter stenosis 
70%). For the low-dose group, mean sensitivity was 93±0%, mean specificity was 75±7%, and mean accuracy was 85±3%.
Conclusions— First-pass perfusion MRI is a safe and accurate test for identifying patients with obstructive coronary artery disease. A low dose of 0.05 mmol/kg gadopentetate dimeglumine is at least as efficacious as higher doses.
Key Words: adenosine • contrast media • ischemia • magnetic resonance imaging • perfusion
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