Echo-planar magnetic resonance myocardial perfusion imaging: Parametric map analysis and comparison with thallium SPECT

Magnetic resonance (MR) perfusion FLASH imaging has been used for assessing coronary artery disease (CAD). Echo-planar MR techniques have advantages i n speed and in making MR perfusion imaging results more clinically accessib le through parametric maps, but have not been previously assessed. We imple mented a spin-echo, echo-planar MR technique and applied it at rest and dur ing adenosine stress in 26 patients with CAD and abnormal thallium single-p hoton-emission computed tomography (SPECT), and analyzed the results by usi ng a newly developed parametric map analysis of time to peak, peak intensit y, and slope of contrast washin. The results were compared with the results of conventional visual analysis of the perfusion cine series. For detectin g abnormal coronary territories, MR and SPECT were comparable for sensitivi ty, specificity, and accuracy (thallium, 70%, 78%, and 73%; MR, 79% 83%, an d 80%; P = NS). There was good agreement between thallium and MR during str ess (kappa = 0.49), but defects were larger by MR (2.4 vs. 3.1 segments for slope; P < 0.01). Additional segments were detected at rest by MR (58 for slope vs. 25 for thallium), which correlated with areas that became abnorma l with stress in the thallium (sensitivity, 100%; specificity, 63%). The pa rametric maps were easier and faster to interpret than review of the origin al first-pass series of images (chi (2) = 10.8; P < 0.04). The diagnostic p erformance of echo-planar perfusion MR and SPECT was similar, and combining the results with parametric mapping was useful for interpretation and cons iderably improved data display for clinical interpretation. MR, however, wa s faster and yielded images of higher resolution with no radiation burden. In multislice mode, these new MR techniques may have clinical value. (C) 20 01 Wiley-Liss, Inc.