Diagnostic performance of stress perfusion and delayed-enhancement MR imaging in patients with coronary artery disease

Radiology. 2006 Jul;240(1):39-45. doi: 10.1148/radiol.2401051161.


Purpose: To prospectively determine the accuracy of a combined magnetic resonance (MR) imaging approach (stress first-pass perfusion imaging followed by delayed-enhancement imaging) for depicting clinically significant coronary artery stenosis (> or = 70% stenosis) in patients suspected of having or known to have coronary artery disease (CAD), with coronary angiography serving as the reference standard.

Materials and methods: The committee on human research approved the study protocol, and all participants gave written informed consent. This study was HIPAA compliant. Forty-seven patients (38 men and nine women; mean age, 63 years +/- 5.3 [standard deviation]) scheduled for coronary angiography were prospectively enrolled: 33 were suspected of having CAD (group A) and 14 had experienced a previous myocardial infarction and were suspected of having new lesions (group B). The MR imaging protocol included cine function, gadolinium-enhanced stress and rest first-pass perfusion MR imaging, and delayed-enhancement MR imaging. Myocardial ischemia was defined as a segment with perfusion deficit at stress first-pass perfusion MR imaging and no hyperenhancement at delayed-enhancement imaging. Myocardial infarction was defined as an area with hyperenhancement at delayed-enhancement imaging.

Results: One patient was excluded from analysis because of poor-quality MR images. Coronary angiography depicted significant stenosis in 30 of 46 patients (65%). In a per-vessel analysis (n = 138), stress first-pass perfusion MR imaging and delayed-enhancement imaging yielded sensitivity of 0.87, specificity of 0.89, and accuracy of 0.88, when compared with coronary angiography. The diagnostic accuracy of stress first-pass perfusion MR imaging and delayed-enhancement imaging was slightly better than that of stress and rest first-pass perfusion MR imaging in the entire population (0.88 vs 0.85), in group A (0.86 vs 0.82), and in group B (0.93 vs 0.90).

Conclusion: Stress first-pass perfusion MR imaging followed by delayed-enhancement imaging is an accurate method to depict significant coronary stenosis in patients suspected of having or known to have CAD.

Publication types

  • Evaluation Study

MeSH terms

  • Aminophylline / pharmacology
  • Cardiotonic Agents / pharmacology
  • Contrast Media
  • Coronary Angiography*
  • Coronary Artery Disease / diagnosis*
  • Coronary Stenosis / diagnosis*
  • Dipyridamole / pharmacology
  • Female
  • Gadolinium DTPA
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Myocardial Infarction / pathology
  • Myocardial Ischemia / pathology
  • Prospective Studies
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Vasodilation / drug effects
  • Vasodilator Agents / pharmacology


  • Cardiotonic Agents
  • Contrast Media
  • Vasodilator Agents
  • Aminophylline
  • Dipyridamole
  • Gadolinium DTPA