Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis

Allison D Ta; Li-Yueh Hsu; Hannah M Conn; Susanne Winkler; Anders M Greve; Sujata M Shanbhag; Marcus Y Chen; W Patricia Bandettini; Andrew E Arai

doi:10.1186/s12968-018-0436-0

Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis

Allison D Ta, Li-Yueh Hsu, Hannah M Conn, Susanne Winkler, Anders M Greve, Sujata M Shanbhag, Marcus Y Chen, W Patricia Bandettini, Andrew E Arai

21 Citations (Scopus)

Abstract

BACKGROUND: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion.

METHODS: Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50% diameter stenosis or computed tomographic coronary angiography (CTA) < 30% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level.

RESULTS: In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level.

CONCLUSION: Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.

Original language	English
Journal	Journal of Cardiovascular Magnetic Resonance
Volume	20
Issue number	1
Pages (from-to)	16
ISSN	1532-429X
DOIs	https://doi.org/10.1186/s12968-018-0436-0
Publication status	Published - 8 Mar 2018
Externally published	Yes

Keywords

Adult
Aged
Artifacts
Blood Flow Velocity
Coronary Angiography
Coronary Artery Disease/diagnostic imaging
Coronary Circulation
Coronary Stenosis/diagnostic imaging
Coronary Vessels/diagnostic imaging
Female
Humans
Image Interpretation, Computer-Assisted/methods
Magnetic Resonance Imaging/methods
Male
Middle Aged
Myocardial Perfusion Imaging/methods
Predictive Value of Tests
Purines/administration & dosage
Pyrazoles/administration & dosage
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Vasodilator Agents/administration & dosage

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10.1186/s12968-018-0436-0

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Ta, A. D., Hsu, L.-Y., Conn, H. M., Winkler, S., Greve, A. M., Shanbhag, S. M., Chen, M. Y., Patricia Bandettini, W., & Arai, A. E. (2018). Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis. Journal of Cardiovascular Magnetic Resonance, 20(1), 16. https://doi.org/10.1186/s12968-018-0436-0

Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis. / Ta, Allison D; Hsu, Li-Yueh; Conn, Hannah M et al.
In: Journal of Cardiovascular Magnetic Resonance, Vol. 20, No. 1, 08.03.2018, p. 16.

Research output: Contribution to journal › Journal article › Research › peer-review

Ta, AD, Hsu, L-Y, Conn, HM, Winkler, S, Greve, AM, Shanbhag, SM, Chen, MY, Patricia Bandettini, W & Arai, AE 2018, 'Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis', Journal of Cardiovascular Magnetic Resonance, vol. 20, no. 1, pp. 16. https://doi.org/10.1186/s12968-018-0436-0

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title = "Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis",

abstract = "BACKGROUND: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion.METHODS: Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50\% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50\% diameter stenosis or computed tomographic coronary angiography (CTA) < 30\% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level.RESULTS: In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30\% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56\% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89\% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level.CONCLUSION: Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.",

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author = "Ta, \{Allison D\} and Li-Yueh Hsu and Conn, \{Hannah M\} and Susanne Winkler and Greve, \{Anders M\} and Shanbhag, \{Sujata M\} and Chen, \{Marcus Y\} and \{Patricia Bandettini\}, W and Arai, \{Andrew E\}",

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doi = "10.1186/s12968-018-0436-0",

language = "English",

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pages = "16",

journal = "Journal of Cardiovascular Magnetic Resonance",

issn = "1532-429X",

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T1 - Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis

AU - Ta, Allison D

AU - Hsu, Li-Yueh

AU - Conn, Hannah M

AU - Winkler, Susanne

AU - Greve, Anders M

AU - Shanbhag, Sujata M

AU - Chen, Marcus Y

AU - Patricia Bandettini, W

AU - Arai, Andrew E

PY - 2018/3/8

Y1 - 2018/3/8

N2 - BACKGROUND: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion.METHODS: Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50% diameter stenosis or computed tomographic coronary angiography (CTA) < 30% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level.RESULTS: In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level.CONCLUSION: Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.

AB - BACKGROUND: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion.METHODS: Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis. Non-significant CAD (NonCAD) was defined as stenosis by QCA < 50% diameter stenosis or computed tomographic coronary angiography (CTA) < 30% in all major epicardial arteries. Dark rim artifacts had study specific and guideline-based definitions for comparison purposes. MBF was quantified at the pixel-level and sector-level.RESULTS: In a NonCAD subgroup with dark rim artifacts, stress MBF was lower in the subendocardial than midmyocardial and epicardial layers (2.17 ± 0.61 vs. 3.06 ± 0.75 vs. 3.24 ± 0.80 mL/min/g, both p < 0.001) and was also 30% lower than in remote regions (2.17 ± 0.61 vs. 2.83 ± 0.67 mL/min/g, p < 0.001). However, subendocardial stress MBF in dark rim artifacts was 37-56% higher than in true perfusion defects (2.17 ± 0.61 vs. 0.95 ± 0.43 mL/min/g, p < 0.001). Absolute stress MBF differentiated CAD from NonCAD with an accuracy ranging from 86 to 89% (all p < 0.001) using pixel-level analyses. Similar results were seen at a sector level.CONCLUSION: Quantitative stress MBF is lower in dark rim artifacts than remote myocardium but significantly higher than in true perfusion defects. If confirmed in larger series, this approach may aid the interpretation of clinical stress perfusion exams.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00027170 ; first posted 11/28/2001; updated 11/27/2017.

KW - Adult

KW - Aged

KW - Artifacts

KW - Blood Flow Velocity

KW - Coronary Angiography

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Circulation

KW - Coronary Stenosis/diagnostic imaging

KW - Coronary Vessels/diagnostic imaging

KW - Female

KW - Humans

KW - Image Interpretation, Computer-Assisted/methods

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Middle Aged

KW - Myocardial Perfusion Imaging/methods

KW - Predictive Value of Tests

KW - Purines/administration & dosage

KW - Pyrazoles/administration & dosage

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Vasodilator Agents/administration & dosage

UR - https://www.scopus.com/pages/publications/85043297861

U2 - 10.1186/s12968-018-0436-0

DO - 10.1186/s12968-018-0436-0

M3 - Journal article

C2 - 29514708

SN - 1532-429X

VL - 20

SP - 16

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

IS - 1

ER -

Fully quantitative pixel-wise analysis of cardiovascular magnetic resonance perfusion improves discrimination of dark rim artifact from perfusion defects associated with epicardial coronary stenosis

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