2D high resolution versus 3D whole heart myocardial perfusion CMR

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Background Developments in myocardial perfusion cardiovascular magnetic resonance (CMR) allow improvements in spatial resolution and/or myocardial coverage. Whole heart coverage may provide the most accurate assessment of myocardial ischaemic burden while high spatial resolution is expected to improve detection of subendocardial ischemia. The objective of this study was to compare the incidence of perfusion defects and the myocardial ischaemic burden as depicted by 2D high resolution and 3D whole heart stress myocardial perfusion in patients with coronary artery disease. Methods and Results 38 patients (age 61±8 [21% female]) underwent 2D high resolution (spatial resolution 1.2mm2) and 3D whole heart (in-plane spatial resolution 2.3mm2) stress CMR at 3-Tesla in randomised order. Myocardial ischaemic burden (%) was visually quantified as perfusion defect at peak stress perfusion subtracted from subendocardial myocardial scar and expressed as a percentage of the myocardium. Median myocardial ischaemic burden was significantly higher with 2D high resolution compared to 3D whole heart (16.1[2.0-30.6] versus 13.4[5.2-23.2], p=0.004). There was excellent agreement between myocardial ischaemic burden (ICC 0.81 (p<0.0001)), with mean ratio difference between 2D high resolution versus 3D whole heart 1.28±0.67 (95% limits of agreement -0.03 to 2.59). When using a 10% threshold for a dichotomous result for presence or absence of significant ischemia, there was moderate agreement between the methods (κ=0.58, p<0.0001). Conclusion 2D high resolution 3D whole heart myocardial perfusion stress CMR are comparable for detection of ischemia. 2D high resolution gives higher values for myocardial ischaemic burden compared to 3D whole heart, suggesting that 2D high resolution is more sensitive for the detection of ischemia.
Original languageEnglish
JournalEuropean Heart Journal-Cardiovascular Imaging
Publication statusAccepted/In press - 18 May 2021


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