Volume 54, Issue 4 pp. 1268-1279

Original Research

Diagnostic Accuracy of Spiral Whole-Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1-SPIRIT

Jonathan A. Pan MD,

Jonathan A. Pan MD

orcid.org/0000-0001-5938-4799

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Co-first authors.

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Austin A. Robinson MD,

Austin A. Robinson MD

Division of Cardiovascular Diseases, Division of Radiology, Scripps Clinic, La Jolla, California, USA

Co-first authors.

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Yang Yang PhD,

Yang Yang PhD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

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Patricia Rodriguez Lozano MD,

Patricia Rodriguez Lozano MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

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Stephen McHugh MD,

Stephen McHugh MD

Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA

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Eric M. Holland MD,

Eric M. Holland MD

Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

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Craig H. Meyer PhD,

Craig H. Meyer PhD

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA

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Angela M. Taylor MD,

Angela M. Taylor MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

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Christopher M. Kramer MD,

Christopher M. Kramer MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

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Michael Salerno MD, PhD,

Corresponding Author

Michael Salerno MD, PhD

[email protected]

orcid.org/0000-0001-7051-1031

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA

Address reprint requests to: M.S., 1215 Lee Street, Box 800158 Charlottesville, Virginia 22908, USA. E-mail: [email protected]

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Jonathan A. Pan MD,

Jonathan A. Pan MD

orcid.org/0000-0001-5938-4799

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Co-first authors.

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Austin A. Robinson MD,

Austin A. Robinson MD

Division of Cardiovascular Diseases, Division of Radiology, Scripps Clinic, La Jolla, California, USA

Co-first authors.

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Yang Yang PhD,

Yang Yang PhD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

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Patricia Rodriguez Lozano MD,

Patricia Rodriguez Lozano MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

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Stephen McHugh MD,

Stephen McHugh MD

Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA

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Eric M. Holland MD,

Eric M. Holland MD

Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

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Craig H. Meyer PhD,

Craig H. Meyer PhD

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA

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Angela M. Taylor MD,

Angela M. Taylor MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

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Christopher M. Kramer MD,

Christopher M. Kramer MD

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

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Michael Salerno MD, PhD,

Corresponding Author

Michael Salerno MD, PhD

[email protected]

orcid.org/0000-0001-7051-1031

Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA

Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA

Address reprint requests to: M.S., 1215 Lee Street, Box 800158 Charlottesville, Virginia 22908, USA. E-mail: [email protected]

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First published: 06 April 2021

https://doi.org/10.1002/jmri.27620

Citations: 2

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Abstract

Background

Variable density spiral (VDS) pulse sequences with motion compensated compressed sensing (MCCS) reconstruction allow for whole-heart quantitative assessment of myocardial perfusion but are not clinically validated.

Purpose

Assess performance of whole-heart VDS quantitative stress perfusion with MCCS to detect obstructive coronary artery disease (CAD).

Study Type

Prospective cross sectional.

Population

Twenty-five patients with chest pain and known or suspected CAD and nine normal subjects.

Field strength/Sequence

Segmented steady-state free precession (SSFP) sequence, segmented phase sensitive inversion recovery sequence for late gadolinium enhancement (LGE) imaging and VDS sequence at 1.5 T for rest and stress quantitative perfusion at eight short-axis locations.

Assessment

Stenosis was defined as ≥50% by quantitative coronary angiography (QCA). Visual and quantitative analysis of MRI data was compared to QCA. Quantitative analysis assessed average myocardial perfusion reserve (MPR), average stress myocardial blood flow (MBF), and lowest stress MBF of two contiguous myocardial segments. Ischemic burden was measured visually and quantitatively.

Statistical Tests

Student's t-test, McNemar's test, chi-square statistic, linear mixed-effects model, and area under receiver-operating characteristic curve (ROC).

Results

Per-patient visual analysis demonstrated a sensitivity of 84% (95% confidence interval [CI], 60%–97%) and specificity of 83% [95% CI, 36%–100%]. There was no significant difference between per-vessel visual and quantitative analysis for sensitivity (69% [95% CI, 51%–84%] vs. 77% [95% CI, 60%–90%], P = 0.39) and specificity (88% [95% CI, 73%–96%] vs. 80% [95% CI, 64%–91%], P = 0.75). Per-vessel quantitative analysis ROC showed no significant difference (P = 0.06) between average MPR (0.68 [95% CI, 0.56–0.81]), average stress MBF (0.74 [95% CI, 0.63–0.86]), and lowest stress MBF (0.79 [95% CI, 0.69–0.90]). Visual and quantitative ischemic burden measurements were comparable (P = 0.85).

Data Conclusion

Whole-heart VDS stress perfusion demonstrated good diagnostic accuracy and ischemic burden evaluation. No significant difference was seen between visual and quantitative diagnostic performance and ischemic burden measurements.

Evidence Level

Technical Efficacy

Stage 2

Supporting Information

Filename

Description

jmri27620-sup-0001-FigureS1.gifGIF image, 19.9 MB

Supplemental Figure 1. Stress and rest perfusion movies in obstructive 2-vessel CAD with an occluded RCA. In reference to the subject in Figure 2 and 3 with obstructive 2-vessel disease, stress (top panel) and rest (bottom panel) perfusion movies are shown. Perfusion defects are seen in the inferior and inferolateral segments during stress.

jmri27620-sup-0002-FigureS2.gifGIF image, 19.8 MB

Supplemental Figure 2. Stress and rest perfusion movies in obstructive 3-vessel CAD. In reference to the subject in Figure 4 and 5 with obstructive 3-vessel disease, stress (top panel) and rest (bottom panel) perfusion movies are shown. Perfusion defects can be seen in all vessel territories during stress.

jmri27620-sup-0003-FigureS3 and FigureS4.docxccdlication/msword, 136.9 KB

Supplemental Figure 3. Bland-Altman Plot of Intra-Observer Limits of Agreement. Includes a subset of 10 patients, including both rest and stress flows. The upper and lower 95% confidence intervals are shown in red and the mean difference is shown in blue.

Supplemental Figure 4. Bland-Altman Plot of Inter-Observer Limits of Agreement. Includes a subset of 10 patients, including both rest and stress flows. The upper and lower 95% confidence intervals are shown in red and the mean difference is shown in blue.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume54, Issue4

October 2021

Pages 1268-1279

Diagnostic Accuracy of Spiral Whole-Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1-SPIRIT

Abstract

Background

Purpose

Study Type

Population

Field strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

Supporting Information

References

Citing Literature

References

Information

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Diagnostic Accuracy of Spiral Whole-Heart Quantitative Adenosine Stress Cardiovascular Magnetic Resonance With Motion Compensated L1-SPIRIT

Abstract

Background

Purpose

Study Type

Population

Field strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

Supporting Information

References

Citing Literature

References

Related

Information