DETECTION OF MYOCARDIAL-ISCHEMIA - VALUE OF COMBINED MYOCARDIAL PERFUSION AND CINEANGIOGRAPHIC MR-IMAGING

OBJECTIVE. Established noninvasive methods for assessing myocardial is chemia have limitations that might be overcome by MR imaging. We inves tigated MR myocardial perfusion imaging and MR ventriculography, befor e and after dipyridamole-induced stress, to determine whether the supe rior spatial and temporal resolution of MR imaging has advantages for the evaluation of myocardial ischemia. SUBJECTS AND METHODS. Eighteen patients with symptoms suggestive of myocardial ischemia were examined by use of MR perfusion imaging and MR cineangiography before and duri ng dipyridamole-induced stress. Multiplanar gradient-echo MR cineangio graphy and cardiac gated fast low-angle shot (turbo-FLASH) MR imaging during injection of gadopentetate dimeglumine were used. Results were compared with findings from perfusion scintigraphy and coronary arteri ography. RESULTS. The accuracy of the combination MR technique for det ecting myocardial ischemia was similar to that of scintigraphy. No sig nificant difference was found between the MR technique and scintigraph y for detecting segments of myocardium supplied by stenosed coronary a rteries (>70% reduction in diameter, as determined by coronary arterio graphy). The sensitivity of the combination MR technique for angiograp hically detecting significant coronary artery narrowing was 92%, and t he specificity was 100%. For scintigraphy, the sensitivity was also 92 % and the specificity was 100%. CONCLUSION. Initial results indicate t hat a combination of stress MR myocardial perfusion imaging and MR ven triculography is feasible and that this technique can detect myocardia l ischemia with an accuracy similar to that of scintigraphy. This tech nique make more complete noninvasive assessment of myocardial ischemia possible.