Noninvasive stress testing of myocardial ischemia: Comparison of GRE-MRI perfusion and wall motion analysis to Tc-99m-MIBI-SPECT, relation to coronary angiography

In the evaluation of ischemic heart disease only MR imaging seems to have the potential to assess myocardial perfusion, function, and coronary morphology on a single instrument. The aim of this study was to assess the feasibility of a stress test with dipyridamole (0.56 mg/kg) to analyze myocardial perfusion by Gd first-pass enhancement in ultrafast gradient-recall-echo MRI (perf-MRI), and wall motion by cine gradient-recall-echo MRI (Cine-MRI) in one imaging session. Twelve patients underwent complete rest and stress studies; satisfactory MR images were acquired in 10 patients. By Tc-99m-MIBI-SPECT sensitivities to detect ischemic segments were 66.7% with Perf-MRI, 80.0% with WM-MRI and 86.7% for Perf-WM-MRI (Perf-MRI vs Perf-WM-MRI; p = 0.03). Scar was equally detected with a sensitivity of 91.6% with either MRI technique. Thus, Perf-Cine-MRI provides complementary information for the management of ischemic heart disease and has a higher sensitivity than Perf-MRI alone.