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An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
Department of Radiology, Ryhov County Hospital, Jönköping.
Department of Radiology, Ryhov County Hospital, Jönköping / Department of Clinical Physiology, Karolinska University Hospital, Stockholm.
Department of Clinical Physiology, Kalmar County Hospital, Kalmar.
Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University / Department of Oncology, Hospital Physics, Ryhov County Hospital, Jönköping.
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2017 (Engelska)Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, nr 1, s. 52-61Artikel i tidskrift (Refereegranskat) Published
Resurstyp
Text
Abstract [en]

Background To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference. Methods Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study. Results Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI). Conclusion GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2017. Vol. 37, nr 1, s. 52-61
Nyckelord [en]
cardiac imaging techniques, coronary heart disease, Magnetic Resonance Imaging, nuclear medicine, perfusion
Nationell ämneskategori
Radiologi och bildbehandling Medicinsk laboratorie- och mätteknik Medicinsk bildbehandling Klinisk medicin
Identifikatorer
URN: urn:nbn:se:liu:diva-130795DOI: 10.1111/cpf.12267ISI: 000390688200008PubMedID: 26147785OAI: oai:DiVA.org:liu-130795DiVA, id: diva2:955017
Anmärkning

Funding agencies: Medical Research Council of Southeast Sweden [12437]; Futurum, the County council of Jonkoping [12440, 81851, 217261]; Linkoping University; County Council of Ostergotland [281281]; Swedish Heart-Lung Foundation [20120449]

Tillgänglig från: 2016-08-24 Skapad: 2016-08-24 Senast uppdaterad: 2017-11-28Bibliografiskt granskad
Ingår i avhandling
1. Magnetic Resonance Imaging of the Heart: Image quality, measurement accuracy and patient experience
Öppna denna publikation i ny flik eller fönster >>Magnetic Resonance Imaging of the Heart: Image quality, measurement accuracy and patient experience
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown.

Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients.

Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies.

Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV).

Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2016. s. 74
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1524
Nationell ämneskategori
Radiologi och bildbehandling Medicinsk bildbehandling Kardiologi Medicinsk laboratorie- och mätteknik Allmänmedicin
Identifikatorer
urn:nbn:se:liu:diva-130796 (URN)10.3384/diss.diva-130796 (DOI)9789176857427 (ISBN)
Disputation
2016-09-30, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2016-08-24 Skapad: 2016-08-24 Senast uppdaterad: 2018-01-10Bibliografiskt granskad

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Ahlander, Britt-MarieMaret, EvaEngvall, Jan
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Avdelningen för kardiovaskulär medicinCentrum för medicinsk bildvetenskap och visualisering, CMIVMedicinska fakultetenFysiologiska kliniken US
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Clinical Physiology and Functional Imaging
Radiologi och bildbehandlingMedicinsk laboratorie- och mätteknikMedicinsk bildbehandlingKlinisk medicin

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