Potential of qualitative and semi-quantitative analysis of myocardial perfusion according to stress adenosine triphosphate perfusion cardiac MRI in the diagnosis of obstructive coronary artery disease

Abstract

Aim. To evaluate the potential of qualitative and semi-quantitative analysis of stress adenosine triphosphate perfusion cardiac magnetic resonance imaging (MRI) in patients with obstructive coronary artery disease (CAD) with stenosis ≥50%.Material and methods. Cardiac adenosine triphosphate perfusion stress MRI was performed in 49 patients with suspected or diagnosed CAD. The images were assessed qualitatively and semi-quantitatively. A zone of reduced signal intensity during the first passage of a contrast bolus with stress was taken as a stress-induced perfusion defect. Semiquantitative analysis was based on the construction of signal intensity curves of the contrast agent entering the left ventricular cavity and into the myocardium.Results. The detection of stress-induced perfusion defects according to cardiac stress MRI was significantly associated with coronary artery stenosis ≥50% (p<0,001) with sensitivity and specificity of 74,3 and 59,8%, respectively. The median myocardial perfusion reserve index (MPRI) was significantly lower in areas of coronary artery blood supply systems with stenosis ≥50% (1,25 [1,14-1,56]) than in areas with stenosis <50% (1,44 [1,21-1,70] (p=0,034). MPRI ≤1,33 in the areas of the coronary artery blood supply suggests coronary artery stenosis ≥50% (sensitivity, 64,52%, specificity, 63,95%; area under the curve =0,629±0,056; (0,519-0,738) (p=0,034)). An inverse relationship was established between the mean global MPRI and the number of stress-induced myocardial perfusion defects (r=-0,502, p<0,001).Conclusion. The developed technique of a semi-quantitative analysis with MPRI determination is effective in identifying obstructive CAD with stenosis ≥50% in addition to qualitative analysis.