Hochaufgelöste quantitative MR-tomografische Bestimmung der subendo- und subepimyokardialen Perfusion unter Stress und in Ruhe

Zusammenfassung

Ziel: Die MR-Stress-Perfusionsbildgebung ermöglicht die Quantifizierung der myokardialen Perfusion, die Bestimmung der myokardialen Perfusionsreserve und des Verhältnisses zwischen subendo- und subepikardialer Perfusion. Ziel dieser Studie war es, eine hochauflösende Perfusionssequenz gegenüber einer Standard-Sequenz zu evaluieren. Material und Methoden: Bei 10 herzgesunden Probandinnen und Probanden wurden First-Pass-Perfusionsuntersuchungen in Ruhe und unter Adenosin-Stress in Präbolus-Technik an einem 1,5-T-Gerät durchgeführt. Verwendet wurde eine SR-True-FISP-GRAPPA-Sequenz (Beschleunigungsfaktor 3) mit einer Auflösung von 1,8 × 1,8 mm. Als Vergleichskollektiv diente eine Gruppe von 12 weiteren herzgesunden Probanden, die am selben Gerät ebenso in Ruhe und Stress mit einer Standard-SR-TrueFISP-Sequenz und einer Auflösung von 2,7 × 3,3 mm untersucht wurden. Die myokardialen Konturen wurden manuell umfahren, automatisch in zwei Bereiche gleicher Dicke sowie acht Sektoren unterteilt und mit Basislinien- und Kontaminationskorrektur ausgewertet. Ergebnisse: Bei der GRAPPA-Sequenz ergab sich in Ruhe eine Verhältnis von subendo- zu subepimyokardialer Perfusion von 1,18 ± 0,32. Unter pharmakologisch induziertem Stress betrug das Verhältnis 1,08 ± 0,27. Für die Standard-Sequenz betrug das Verhältnis in Ruhe 1,15 ± 0,28 und unter Stress 1,11 ± 0,33. Für die hochauflösende Sequenz finden sich höhere Mittelwerte des Verhältnisses von subendo- zu subepimyokardialer Perfusion bei vergleichbaren Standardabweichungen, wobei die Unterschiede zwischen den Sequenzen noch nicht statistisch signifikant sind. Schlussfolgerungen: Die Bestimmung der subendomyokardialen und subepimyokardialen Perfusion ist mit einer hochauflösenden First-Pass-Perfusionssequenz möglich. Die hierbei zur Vermeidung systematischer Fehler eingesetzte höhere räumliche Auflösung führt zwar zu höherem Bildrauschen, jedoch nicht zu einer merklichen Verschlechterung der quantitativen Perfusionswerte unter Stress- und Ruhebedingungen.

Abstract

Purpose: MR stress perfusion imaging of the heart allows the quantification of myocardial perfusion and the evaluation of myocardial perfusion reserve (MPR) and the ratio of subendocardial to subepicardial perfusion at rest and under adenosine stress. The aim of this study was to evaluate a high-resolution GRAPPA sequence for quantitative MR first pass perfusion imaging in healthy volunteers. Materials and Methods: First pass stress and rest perfusion studies were performed on 10 healthy volunteers using a 1.5 T MR scanner with a multislice SR-TrueFISP first pass perfusion sequence with a GRAPPA algorithm (acceleration factor 3) in prebolus technique and an image resolution of 1.8 × 1.8 mm. For the comparison group, we examined 12 different healthy volunteers with a standard first pass perfusion SR-TrueFISP sequence using a resolution of 2.7 × 3.3 mm. Myocardial contours were manually delineated followed by an automatic division of the myocardium into two rings with an equal thickness for the subendo- and subepicardial layer. Eight sectors per slice were evaluated using contamination and baseline correction. Results: Using the GRAPPA sequence, the ratio of subendo- to subepimyocardial perfusion was 1.18 ± 0.32 for the examination at rest. Under pharmacologically induced stress, the ratio was 1.08 ± 0.27. For the standard sequence the ratio was 1.15 ± 0.28 at rest and 1.11 ± 0.33 under stress. For the high resolution sequence higher mean values for the subendo- to subepimyocardial ratio were obtained with comparable standard deviations. The difference between the sequences was not significant. Conclusion: The evaluation of subendomyocardial and subepimyocardial perfusion is feasible with a high-resolution first pass perfusion sequence. The use of a higher resolution to avoid systematic error leads to increased image noise. However, no relevant reduction in the quantitative perfusion values under stress and at rest was able to be depicted.

Key words

magnetic resonance tomography - myocardial stress perfusion - quantitative first pass perfusion - high-resolution MR imaging

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