Vergleich der Perfusionsdiagnostik mittels Magnetresonanztomographie mit dem invasiv bestimmten hämodynamischen Schweregrad von Koronarstenosen zur Detektion der hämodynamischen Relevanz von Stenosen der Koronararterien

Multislice first-pass perfusion cardiovascular magnetic resonance (FP-CMR) imaging has shown great promise for the detection of significant coronary artery disease (CAD). This study evaluated whether FP-CMR could predict the hemodynamic significance of epicardial coronary artery stenosis as defined by invasively determined fractional flow reserve at coronary angiography. All patients were examined in rest and under adenosine-stress on a clinical 1.5-T scanner (Intera, Philips). Stress perfusion imaging was performed using a continuous intravenous infusion of adenosine 140 µg/kg/min. In 19 patients with known coronary artery disease (CAD), the hemodynamic relevance of 22 stenoses (mean angiographic severity 73 ± 9%) was determined using fractional flow reserve measurements (cutoff 0.75). Results were compared with a territorial index of myocardial perfusion reserve (MPR) derived from FP-CMR. In addition, 9 age-matched patients with low prevalence of risk factors and without CAD at angiography served as a control group. A cutoff of 1.5 for MPR separated hemodynamically relevant from nonrelevant stenoses with a sensitivity and specificity of 92% and 92%, respectively. The area under the receiver-operating characteristic (ROC) curve was 0.97. In the patient group, territories supplied by arteries without significant stenosis (<50%) showed a lower MPR compared with the control group (p