Abstract
BackgroundQuantitative assessment of myocardial blood flow (MBF) from cardiovascular magnetic resonance (CMR) perfusion images appears to offer advantages over qualitative assessment. Currently however, clinical translation is lacking, at least in part due to considerable disparity in quantification methodology. The aim of this study was to evaluate the effect of common methodological differences in CMR voxel-wise measurement of MBF, using position emission tomography (PET) as external validation.MethodsEighteen subjects, including 9 with significant coronary artery disease (CAD) and 9 healthy volunteers prospectively underwent perfusion CMR. Comparison was made between MBF quantified using: 1. Calculated contrast agent concentration curves (to correct for signal saturation) versus raw signal intensity curves; 2. Mid-ventricular versus basal-ventricular short-axis arterial input function (AIF) extraction; 3. Three different deconvolution approaches; Fermi function parameterization, truncated singular value decomposition (TSVD) and first-order Tikhonov regularization with b-splines. CAD patients also prospectively underwent rubidium-82 PET (median interval 7 days).ResultsMBF was significantly higher when calculated using signal intensity compared to contrast agent concentration curves, and when the AIF was extracted from mid- compared to basal-ventricular images. MBF did not differ significantly between Fermi and Tikhonov, or between Fermi and TVSD deconvolution methods although there was a small difference between TSVD and Tikhonov (0.06 mL/min/g). Agreement between all deconvolution methods was high. MBF derived using each CMR deconvolution method showed a significant linear relationship (p < 0.001) with PET-derived MBF however each method underestimated MBF compared to PET (by 0.19 to 0.35 mL/min/g).ConclusionsVariations in more complex methodological factors such as deconvolution method have no greater effect on estimated MBF than simple factors such as AIF location and observer variability. Standardization of the quantification process will aid comparison between studies and may help CMR MBF quantification enter clinical use.
Highlights
Quantitative assessment of myocardial blood flow (MBF) from cardiovascular magnetic resonance (CMR) perfusion images appears to offer advantages over qualitative assessment
The aim of this study was primarily to evaluate the effect that common methodological differences in CMR MBF quantification have on voxel-wise measurement of MBF in patients with coronary artery disease (CAD) and in healthy volunteers
arterial input function (AIF) location Mean MBF was significantly higher when the AIF was extracted from the blood pool in the mid-ventricular shortaxis images compared to when it was extracted from the blood pool in the basal-ventricular images (Table 2)
Summary
Quantitative assessment of myocardial blood flow (MBF) from cardiovascular magnetic resonance (CMR) perfusion images appears to offer advantages over qualitative assessment. The aim of this study was to evaluate the effect of common methodological differences in CMR voxel-wise measurement of MBF, using position emission tomography (PET) as external validation. Cardiovascular magnetic resonance (CMR) perfusion imaging, involving qualitative assessment of the first-pass of contrast agent though the myocardium, has emerged as an effective method of diagnosing CAD [2]. Quantitative assessment of myocardial blood flow (MBF) overcomes this limitation, it has been used to provide pathophysiological insight into conditions where microvascular disease is manifest [3]. Studies using positron emission tomography (PET) have demonstrated the superiority of MBF quantification over qualitative and semi-quantitative methods for identification of CAD [5,6]
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