Three-dimensional whole-heart vs. two-dimensional high-resolution perfusion-CMR: a pilot study comparing myocardial ischaemic burden

• Published in: European heart journal cardiovascular imaging Vol. 17; no. 8; p. 900
• Main Authors: McDiarmid, Adam K, Ripley, David P, Mohee, Kevin, Kozerke, Sebastian, Greenwood, John P, Plein, Sven, Motwani, Manish
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Aged; Angina Pectoris - diagnostic imaging; Angina Pectoris - physiopathology; Cohort Studies; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Linear Models; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Myocardial Perfusion Imaging - methods; Pilot Projects; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Statistics, Nonparametric; coronary artery disease; ischaemia; magnetic resonance imaging; myocardial perfusion imaging
• ISSN: 2047-2412
• DOI: 10.1093/ehjci/jev231

Typically, myocardial perfusion imaging with two-dimensional (2D) cardiovascular magnetic resonance (CMR) acquires data in three to four myocardial slices at a spatial resolution of 2-3 mm. However, accelerated data acquisition can facilitate higher spatial resolution (<2 mm) or three-dimensional (3D) whole-heart coverage (up to 16 slices). This study aims to compare image quality, diagnostic confidence, and quantitation of myocardial ischaemic burden (MIB) between 2D high-resolution and 3D whole-heart perfusion-CMR. Twenty-seven patients with stable angina underwent both high-resolution 2D and whole-heart 3D perfusion-CMR. Total perfusion defect (TPD) and total scar burden (TSB) areas were contoured and expressed as percentage myocardium. MIB was calculated by subtracting TSB from TPD. Image quality, artefact, and diagnostic confidence scores were similar for both techniques (P>0.05). The mean MIB from high-resolution and 3D acquisition was similar (4.3±5.2% vs. 4.1±4.9%; P=0.81), with a strong correlation between techniques (r=0.72; P<0.001). There was no systematic bias for estimates of MIB between techniques [mean bias=-0.17%, 95% confidence interval (CI): -1.7 to -1.3%] and the 95% limits of agreement were -7.5 to 7.2%. When used to categorize MIB as >10% or <10%, there was only fair agreement between the two techniques (κ=0.29, 95% CI: -0.12 to 0.70). There is strong correlation and broad agreement between estimates of MIB from both techniques. However, the 95% limits of agreement are relatively wide and therefore a larger comparative study is needed before they can be considered interchangeable-particularly around the clinically relevant 10% threshold.