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Erschienen in: Current Cardiovascular Imaging Reports 4/2014

01.04.2014 | Cardiac Magnetic Resonance (E Nagel and V Puntmann, Section Editors)

Novel Approaches to Myocardial Perfusion: 3D First-Pass CMR Perfusion Imaging and Oxygenation-Sensitive CMR

verfasst von: Dominik P. Guensch, Matthias G. Friedrich

Erschienen in: Current Cardiovascular Imaging Reports | Ausgabe 4/2014

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Abstract

This article reviews technical aspects and the current status of novel cardiovascular magnetic resonance (CMR) approaches to assessing myocardial perfusion, specifically oxygenation-sensitive magnetic resonance imaging, comparing their diagnostic targets and clinical role with those of other imaging approaches. The paper includes discussions of relevant pathophysiological aspects of myocardial ischemia and the clinical context of revascularization in patients with suspected or known coronary artery disease. Research using oxygenation-sensitive CMR may play an important role for a better understanding of the interplay of coronary artery stenosis, blood flow reduction, and their impact on actual myocardial ischemia.
Literatur
1.
Zurück zum Zitat Tonino PAL, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multi-vessel evaluation. J Am Coll Cardiol. 2010;55:2816–21.PubMedCrossRef Tonino PAL, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multi-vessel evaluation. J Am Coll Cardiol. 2010;55:2816–21.PubMedCrossRef
2.
Zurück zum Zitat Nakazato R, Park H-B, Berman DS, Gransar H, Koo B-K, Erglis A, et al. Noninvasive fractional flow reserve derived from CT Angiography (FFRCT) for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013. Nakazato R, Park H-B, Berman DS, Gransar H, Koo B-K, Erglis A, et al. Noninvasive fractional flow reserve derived from CT Angiography (FFRCT) for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013.
3.
Zurück zum Zitat Naghavi M. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003;108:1664–72.PubMedCrossRef Naghavi M. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003;108:1664–72.PubMedCrossRef
4.
Zurück zum Zitat Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. 2003;1772–8. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. 2003;1772–8.
5.
Zurück zum Zitat Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009;53:1642–50.PubMedCentralPubMedCrossRef Hoffmann U, Bamberg F, Chae CU, Nichols JH, Rogers IS, Seneviratne SK, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009;53:1642–50.PubMedCentralPubMedCrossRef
6.
Zurück zum Zitat Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.PubMedCrossRef Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.PubMedCrossRef
7.
Zurück zum Zitat Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, Shaw RE, et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ: Cardiovasc Interven. 2012;5:476–90. Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, Shaw RE, et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circ: Cardiovasc Interven. 2012;5:476–90.
8.
Zurück zum Zitat Murata K, Bhargava V, Ricou F, Ono S, Kambayashi M, Oh BH, et al. The influence of coronary collateral flow on the assessment of myocardial perfusion by videodensitometry. Cardiovasc Res. 1997;33:359–69.PubMedCrossRef Murata K, Bhargava V, Ricou F, Ono S, Kambayashi M, Oh BH, et al. The influence of coronary collateral flow on the assessment of myocardial perfusion by videodensitometry. Cardiovasc Res. 1997;33:359–69.PubMedCrossRef
9.
Zurück zum Zitat Fearon WF, Aarnoudse W, Pijls NHJ, De Bruyne B, Balsam LB, Cooke DT, et al. Microvascular resistance is not influenced by epicardial coronary artery stenosis severity: experimental validation. Circulation. 2004;109:2269–72.PubMedCrossRef Fearon WF, Aarnoudse W, Pijls NHJ, De Bruyne B, Balsam LB, Cooke DT, et al. Microvascular resistance is not influenced by epicardial coronary artery stenosis severity: experimental validation. Circulation. 2004;109:2269–72.PubMedCrossRef
10.
Zurück zum Zitat Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379:453–60.PubMedCentralPubMedCrossRef Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet. 2012;379:453–60.PubMedCentralPubMedCrossRef
11.•
Zurück zum Zitat Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59:1719–28. Meta-analysis of all currently available techniques to detect myocardial ischemia and its surrogates. PubMedCrossRef Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a meta-analysis. J Am Coll Cardiol. 2012;59:1719–28. Meta-analysis of all currently available techniques to detect myocardial ischemia and its surrogates. PubMedCrossRef
12.
Zurück zum Zitat Shin T, Hu HH, Pohost GM, Nayak KS. Three dimensional first-pass myocardial perfusion imaging at 3 T: feasibility study. J Cardiovasc Magn Reson. 2008;10:57.PubMedCentralPubMedCrossRef Shin T, Hu HH, Pohost GM, Nayak KS. Three dimensional first-pass myocardial perfusion imaging at 3 T: feasibility study. J Cardiovasc Magn Reson. 2008;10:57.PubMedCentralPubMedCrossRef
13.•
Zurück zum Zitat Jogiya R, Kozerke S, Morton G, De Silva K, Redwood S, Perera D, et al. Validation of dynamic 3-dimensional whole heart magnetic resonance myocardial perfusion imaging against fractional flow reserve for the detection of significant coronary artery disease. J Am Coll Cardiol. 2012;60:756–65. Best evidence so far that 3D CMR first-pass perfusion imaging has a strong clinical potential and compares well with fractional flow reserve as the current gold standard. PubMedCrossRef Jogiya R, Kozerke S, Morton G, De Silva K, Redwood S, Perera D, et al. Validation of dynamic 3-dimensional whole heart magnetic resonance myocardial perfusion imaging against fractional flow reserve for the detection of significant coronary artery disease. J Am Coll Cardiol. 2012;60:756–65. Best evidence so far that 3D CMR first-pass perfusion imaging has a strong clinical potential and compares well with fractional flow reserve as the current gold standard. PubMedCrossRef
14.
Zurück zum Zitat Manka R, Jahnke C, Kozerke S, Vitanis V, Crelier G, Gebker R, et al. Dynamic 3-dimensional stress cardiac magnetic resonance perfusion imaging: detection of coronary artery disease and volumetry of myocardial hypoenhancement before and after coronary stenting. J Am Coll Cardiol. 2011;57:437–44.PubMedCrossRef Manka R, Jahnke C, Kozerke S, Vitanis V, Crelier G, Gebker R, et al. Dynamic 3-dimensional stress cardiac magnetic resonance perfusion imaging: detection of coronary artery disease and volumetry of myocardial hypoenhancement before and after coronary stenting. J Am Coll Cardiol. 2011;57:437–44.PubMedCrossRef
15.•
Zurück zum Zitat Lockie T, Ishida M, Perera D, Chiribiri A, De Silva K, Kozerke S, et al. High-resolution magnetic resonance myocardial perfusion imaging at 3.0-Tesla to detect hemodynamically significant coronary stenoses as determined by fractional flow reserve. J Am Coll Cardiol. 2011;57:70–5. First clinical report on high-resolution CMR first-pass perfusion imaging showing the impact of revascularization on myocardial perfusion. PubMedCrossRef Lockie T, Ishida M, Perera D, Chiribiri A, De Silva K, Kozerke S, et al. High-resolution magnetic resonance myocardial perfusion imaging at 3.0-Tesla to detect hemodynamically significant coronary stenoses as determined by fractional flow reserve. J Am Coll Cardiol. 2011;57:70–5. First clinical report on high-resolution CMR first-pass perfusion imaging showing the impact of revascularization on myocardial perfusion. PubMedCrossRef
16.•
Zurück zum Zitat Motwani M, Maredia N, Fairbairn TA, Kozerke S, Radjenovic A, Greenwood JP, et al. High-resolution versus standard-resolution cardiovascular magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease. Circ Cardiovasc Imaging. 2012. Editorial with a detailed discussion on the comparative value of high-resolution vs 3D/full coverage CMR first-pass perfusion imaging. Motwani M, Maredia N, Fairbairn TA, Kozerke S, Radjenovic A, Greenwood JP, et al. High-resolution versus standard-resolution cardiovascular magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease. Circ Cardiovasc Imaging. 2012. Editorial with a detailed discussion on the comparative value of high-resolution vs 3D/full coverage CMR first-pass perfusion imaging.
17.•
Zurück zum Zitat Phillips LM, Hachamovitch R, Berman DS, Iskandrian AE, Min JK, Picard MH, et al. Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA. J Nucl Cardiol. 2013. Expert consensus paper on the limitations of clinical decision-making in stable coronary artery disease if based on coronary artery stenosis or the mere presence of inducible ischemia. Phillips LM, Hachamovitch R, Berman DS, Iskandrian AE, Min JK, Picard MH, et al. Lessons learned from MPI and physiologic testing in randomized trials of stable ischemic heart disease: COURAGE, BARI 2D, FAME, and ISCHEMIA. J Nucl Cardiol. 2013. Expert consensus paper on the limitations of clinical decision-making in stable coronary artery disease if based on coronary artery stenosis or the mere presence of inducible ischemia.
18.
Zurück zum Zitat Ogawa S, Lee TM, Kay AR, Tank DW. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci U S A. 1990;87:9868–72.PubMedCentralPubMedCrossRef Ogawa S, Lee TM, Kay AR, Tank DW. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci U S A. 1990;87:9868–72.PubMedCentralPubMedCrossRef
19.
Zurück zum Zitat Pauling L, Coryell CD. The magnetic properties and structure of hemoglobin, oxyhemoglobin and carbonmonoxyhemoglobin. Proc Natl Acad Sci U S A. 1936;22:210.PubMedCentralPubMedCrossRef Pauling L, Coryell CD. The magnetic properties and structure of hemoglobin, oxyhemoglobin and carbonmonoxyhemoglobin. Proc Natl Acad Sci U S A. 1936;22:210.PubMedCentralPubMedCrossRef
20.
Zurück zum Zitat Vohringer M, Flewitt JA, Green JD, Dharmakumar R, Wang J, Tyberg JV, et al. Oxygenation-sensitive CMR for assessing vasodilator-induced changes of myocardial oxygenation. J Cardiovasc Magn Reson. 2010;12:20.PubMedCentralPubMedCrossRef Vohringer M, Flewitt JA, Green JD, Dharmakumar R, Wang J, Tyberg JV, et al. Oxygenation-sensitive CMR for assessing vasodilator-induced changes of myocardial oxygenation. J Cardiovasc Magn Reson. 2010;12:20.PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Guensch DP, Fischer K, Flewitt JA, Friedrich MG. Myocardial oxygenation is maintained during hypoxia when combined with apnea—a cardiovascular MR study. Physiol Rep. 2013. Guensch DP, Fischer K, Flewitt JA, Friedrich MG. Myocardial oxygenation is maintained during hypoxia when combined with apnea—a cardiovascular MR study. Physiol Rep. 2013.
22.
Zurück zum Zitat Dharmakumar R, Arumana JM, Tang R, Harris K, Zhang Z, Li D. Assessment of regional myocardial oxygenation changes in the presence of coronary artery stenosis with balanced SSFP imaging at 3.0 T: theory and experimental evaluation in canines. J Magn Reson Imaging. 2008;27:1037–45.PubMedCrossRef Dharmakumar R, Arumana JM, Tang R, Harris K, Zhang Z, Li D. Assessment of regional myocardial oxygenation changes in the presence of coronary artery stenosis with balanced SSFP imaging at 3.0 T: theory and experimental evaluation in canines. J Magn Reson Imaging. 2008;27:1037–45.PubMedCrossRef
24.••
Zurück zum Zitat Guensch DP, Fischer K, Flewitt JA, Yu J, Lukic R, Friedrich JA, et al. Breathing-maneuver dependent changes of myocardial oxygenation in healthy humans. Eur Heart J Cardiovasc Imaging. 2013. First proof in humans that breathing maneuvers have a significant impact on myocardial oxygenation. Guensch DP, Fischer K, Flewitt JA, Yu J, Lukic R, Friedrich JA, et al. Breathing-maneuver dependent changes of myocardial oxygenation in healthy humans. Eur Heart J Cardiovasc Imaging. 2013. First proof in humans that breathing maneuvers have a significant impact on myocardial oxygenation.
25.
Zurück zum Zitat Wacker CM, Hartlep AW, Pfleger S, Schad LR, Ertl G, Bauer WR. Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol. 2003;41:834–40.PubMedCrossRef Wacker CM, Hartlep AW, Pfleger S, Schad LR, Ertl G, Bauer WR. Susceptibility-sensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol. 2003;41:834–40.PubMedCrossRef
26.
Zurück zum Zitat Friedrich MG, Niendorf T, Schulz-Menger J, Gross CM, Dietz R. Blood oxygen level-dependent magnetic resonance imaging in patients with stress-induced angina. Circulation. 2003;108:2219–23.PubMedCrossRef Friedrich MG, Niendorf T, Schulz-Menger J, Gross CM, Dietz R. Blood oxygen level-dependent magnetic resonance imaging in patients with stress-induced angina. Circulation. 2003;108:2219–23.PubMedCrossRef
27.
Zurück zum Zitat Manka R, Paetsch I, Schnackenburg B, Gebker R, Fleck E, Jahnke C. BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia. J Cardiovasc Magn Reson. 2010;12:54.PubMedCentralPubMedCrossRef Manka R, Paetsch I, Schnackenburg B, Gebker R, Fleck E, Jahnke C. BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia. J Cardiovasc Magn Reson. 2010;12:54.PubMedCentralPubMedCrossRef
28.
Zurück zum Zitat Karamitsos TD, Leccisotti L, Arnold JR, Recio-Mayoral A, Bhamra-Ariza P, Howells RK, et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging. 2010;3:32–40.PubMedCrossRef Karamitsos TD, Leccisotti L, Arnold JR, Recio-Mayoral A, Bhamra-Ariza P, Howells RK, et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging. 2010;3:32–40.PubMedCrossRef
29.•
Zurück zum Zitat Walcher T, Manzke R, Hombach V, Rottbauer W, Wöhrle J, Bernhardt P. Myocardial perfusion reserve assessed by T2-prepared steady-state free-precession Blood Oxygen Level-Dependent (BOLD) Magnetic Resonance Imaging in comparison to fractional flow reserve. Circ Cardiovasc Imaging. 2012. First validation of oxygenation-sensitive CMR against fractional flow reserve as another functional marker of coronary artery stenosis severity, confirming a good correlation. Walcher T, Manzke R, Hombach V, Rottbauer W, Wöhrle J, Bernhardt P. Myocardial perfusion reserve assessed by T2-prepared steady-state free-precession Blood Oxygen Level-Dependent (BOLD) Magnetic Resonance Imaging in comparison to fractional flow reserve. Circ Cardiovasc Imaging. 2012. First validation of oxygenation-sensitive CMR against fractional flow reserve as another functional marker of coronary artery stenosis severity, confirming a good correlation.
30.•
Zurück zum Zitat Karamitsos TD, Arnold JR, Pegg TJ, Francis JM, Birks J, Jerosch-Herold M, et al. Patients with Syndrome X have normal transmural myocardial perfusion and oxygenation: a 3-T cardiovascular magnetic resonance imaging study. Circ Cardiovasc Imaging. 2012;5:194–200. Clinical study showing how oxygenation-sensitive CMR can be helpful in differentiating mere blood flow inhomogeneity from actual oxygenation issues. PubMedCrossRef Karamitsos TD, Arnold JR, Pegg TJ, Francis JM, Birks J, Jerosch-Herold M, et al. Patients with Syndrome X have normal transmural myocardial perfusion and oxygenation: a 3-T cardiovascular magnetic resonance imaging study. Circ Cardiovasc Imaging. 2012;5:194–200. Clinical study showing how oxygenation-sensitive CMR can be helpful in differentiating mere blood flow inhomogeneity from actual oxygenation issues. PubMedCrossRef
31.•
Zurück zum Zitat Guensch DP, Fischer K, Flewitt JA, Friedrich MG. Impact of intermittent apnea on myocardial tissue oxygenation—a study using oxygenation-sensitive cardiovascular magnetic resonance. PLoS One. 2013;8:e53282. First proof (animal model) that long breath-holds increase myocardial blood supply and, thus, explain the observed increase of oxygenation despite a decrease of ventricular blood oxygen. The study also showed the correlation of these changes with arterial pCO 2. Guensch DP, Fischer K, Flewitt JA, Friedrich MG. Impact of intermittent apnea on myocardial tissue oxygenation—a study using oxygenation-sensitive cardiovascular magnetic resonance. PLoS One. 2013;8:e53282. First proof (animal model) that long breath-holds increase myocardial blood supply and, thus, explain the observed increase of oxygenation despite a decrease of ventricular blood oxygen. The study also showed the correlation of these changes with arterial pCO 2.
32.
Zurück zum Zitat Zhou X, Tsaftaris SA, Liu Y, Tang R, Klein R, Zuehlsdorff S, et al. Artifact-reduced two-dimensional cine steady state free precession for myocardial blood- oxygen-level-dependent imaging. J Magn Reson Imaging. 2010;31:863–71.PubMedCentralPubMedCrossRef Zhou X, Tsaftaris SA, Liu Y, Tang R, Klein R, Zuehlsdorff S, et al. Artifact-reduced two-dimensional cine steady state free precession for myocardial blood- oxygen-level-dependent imaging. J Magn Reson Imaging. 2010;31:863–71.PubMedCentralPubMedCrossRef
33.
Zurück zum Zitat Shea SM, Fieno DS, Schirf BE, Bi X, Huang J, Omary RA, et al. T2-prepared steady-state free precession blood oxygen level-dependent MR imaging of myocardial perfusion in a dog stenosis model. Radiology. 2005;236:503–9.PubMedCrossRef Shea SM, Fieno DS, Schirf BE, Bi X, Huang J, Omary RA, et al. T2-prepared steady-state free precession blood oxygen level-dependent MR imaging of myocardial perfusion in a dog stenosis model. Radiology. 2005;236:503–9.PubMedCrossRef
Metadaten
Titel
Novel Approaches to Myocardial Perfusion: 3D First-Pass CMR Perfusion Imaging and Oxygenation-Sensitive CMR
verfasst von
Dominik P. Guensch
Matthias G. Friedrich
Publikationsdatum
01.04.2014
Verlag
Springer US
Erschienen in
Current Cardiovascular Imaging Reports / Ausgabe 4/2014
Print ISSN: 1941-9066
Elektronische ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-014-9261-5

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