Magnetic resonance pharmacological stress for detecting coronary disease -Comparison with echocardiography

Stress testing is the cornerstone in the diagnosis of patients with suspect ed coronary artery disease (CAD). Although exercise ECG remains the primary approach far the detection of ischemia in patients with chest gain syndrom es, its sensitivity and specificity is limited and exercise ECG does not pr ovide detailed information about the localisation and extent of CAD. Stress echocardiography has been used for the detection of ischemia for more than a decade and has become an increasingly popular noninvasive method for the detection of CAD. In experienced hands wall motion analysis based on stres s echocardiography has proved to be as sensitive and specific for the detec tion of myocardial ischemia as scintigraphic techniques. Recent technical improvements, namely the availability of ultrafast imaging sequences with a significant reduction of imaging time have initiated seve ral studies which examined the combination of pharmacological stress and ma gnetic resonance imaging (MRI) for the detection of suspected CAD. The most well developed stress-MRT technique is wall motion imaging during dobutami ne stress This technique is analogous to stress echocardiography, but MRI h as the inherent advantages of better resolution, higher reproducibility and true long and short axis imaging with contiguous parallel slices However, the clinical impact of MRI for the diagnosis of CAD is still low Further te chnical developments including real time imaging and a reliable automated q uantitative analysis of left ventricular function are required before stres s-MRI becomes a serious challenge to stressechocardiography in the clinical arena. Currently, only a few MRI facilities and physicians are dedicated t o pharmacological stress testing with MRI and the future clinical impact of this promising technique will depend on its potential to provide informati on beyond myocardial function including perfusion, metabolism and coronary anatomy in form of a "one-stop"-shop for the cardiac patient.