Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification

Xenios Milidonis; Russell Franks; Torben Schneider; Javier Sánchez-González; Eva C. Sammut; Sven Plein; Amedeo Chiribiri

doi:10.1186/s12968-021-00733-4

Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification

Xenios Milidonis^*, Russell Franks, Torben Schneider, Javier Sánchez-González, Eva C. Sammut, Sven Plein, Amedeo Chiribiri

^*Corresponding author for this work

Cardiovascular Imaging

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Background: Quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by cardiovascular magnetic resonance (CMR) perfusion requires sampling of the arterial input function (AIF). While variation in the AIF sampling location is known to impact quantification by CMR and positron emission tomography (PET) perfusion, there is no evidence to support the use of a specific location based on their diagnostic accuracy in the detection of coronary artery disease (CAD). This study aimed to evaluate the accuracy of stress MBF and MPR for different AIF sampling locations for the detection of abnormal myocardial perfusion with expert visual assessment as the reference. Methods: Twenty-five patients with suspected or known CAD underwent vasodilator stress-rest perfusion with a dual-sequence technique at 3T. A low-resolution slice was acquired in 3-chamber view to allow AIF sampling at five different locations: left atrium (LA), basal left ventricle (bLV), mid left ventricle (mLV), apical left ventricle (aLV) and aortic root (AoR). MBF and MPR were estimated at the segmental level using Fermi function-constrained deconvolution. Segments were scored as having normal or abnormal perfusion by visual assessment and the diagnostic accuracy of stress MBF and MPR for each location was evaluated using receiver operating characteristic curve analysis. Results: In both normal (300 out of 400, 75 %) and abnormal segments, rest MBF, stress MBF and MPR were significantly different across AIF sampling locations (p < 0.001). Stress MBF for the AoR (normal: 2.42 (2.15–2.84) mL/g/min; abnormal: 1.71 (1.28–1.98) mL/g/min) had the highest diagnostic accuracy (sensitivity 80 %, specificity 85 %, area under the curve 0.90; p < 0.001 versus stress MBF for all other locations including bLV: normal: 2.78 (2.39–3.14) mL/g/min; abnormal: 2.22 (1.83–2.48) mL/g/min; sensitivity 91 %, specificity 63 %, area under the curve 0.81) and performed better than MPR for the LV locations (p < 0.01). MPR for the AoR (normal: 2.43 (1.95–3.14); abnormal: 1.58 (1.34–1.90)) was not superior to MPR for the bLV (normal: 2.59 (2.04–3.20); abnormal: 1.69 (1.36–2.14); p = 0.717). Conclusions: The AIF sampling location has a significant impact on MBF and MPR estimates by CMR perfusion, with AoR-based stress MBF comparing favorably to that for the current clinical reference bLV.

Original language	English
Article number	35
Journal	Journal of Cardiovascular Magnetic Resonance
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12968-021-00733-4
Publication status	Published - Dec 2021

Keywords

Arterial input
Cardiovascular magnetic resonance
Coronary artery disease
Myocardial blood flow
Myocardial ischemia
Myocardial perfusion quantification
Myocardial perfusion reserve

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12968-021-00733-4

Cite this

Milidonis, X., Franks, R., Schneider, T., Sánchez-González, J., Sammut, E. C., Plein, S., & Chiribiri, A. (2021). Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification. Journal of Cardiovascular Magnetic Resonance, 23(1), Article 35. https://doi.org/10.1186/s12968-021-00733-4

@article{342367f9df16433ca39de64f7a2f1ed6,

title = "Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification",

abstract = "Background: Quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by cardiovascular magnetic resonance (CMR) perfusion requires sampling of the arterial input function (AIF). While variation in the AIF sampling location is known to impact quantification by CMR and positron emission tomography (PET) perfusion, there is no evidence to support the use of a specific location based on their diagnostic accuracy in the detection of coronary artery disease (CAD). This study aimed to evaluate the accuracy of stress MBF and MPR for different AIF sampling locations for the detection of abnormal myocardial perfusion with expert visual assessment as the reference. Methods: Twenty-five patients with suspected or known CAD underwent vasodilator stress-rest perfusion with a dual-sequence technique at 3T. A low-resolution slice was acquired in 3-chamber view to allow AIF sampling at five different locations: left atrium (LA), basal left ventricle (bLV), mid left ventricle (mLV), apical left ventricle (aLV) and aortic root (AoR). MBF and MPR were estimated at the segmental level using Fermi function-constrained deconvolution. Segments were scored as having normal or abnormal perfusion by visual assessment and the diagnostic accuracy of stress MBF and MPR for each location was evaluated using receiver operating characteristic curve analysis. Results: In both normal (300 out of 400, 75 %) and abnormal segments, rest MBF, stress MBF and MPR were significantly different across AIF sampling locations (p < 0.001). Stress MBF for the AoR (normal: 2.42 (2.15–2.84) mL/g/min; abnormal: 1.71 (1.28–1.98) mL/g/min) had the highest diagnostic accuracy (sensitivity 80 %, specificity 85 %, area under the curve 0.90; p < 0.001 versus stress MBF for all other locations including bLV: normal: 2.78 (2.39–3.14) mL/g/min; abnormal: 2.22 (1.83–2.48) mL/g/min; sensitivity 91 %, specificity 63 %, area under the curve 0.81) and performed better than MPR for the LV locations (p < 0.01). MPR for the AoR (normal: 2.43 (1.95–3.14); abnormal: 1.58 (1.34–1.90)) was not superior to MPR for the bLV (normal: 2.59 (2.04–3.20); abnormal: 1.69 (1.36–2.14); p = 0.717). Conclusions: The AIF sampling location has a significant impact on MBF and MPR estimates by CMR perfusion, with AoR-based stress MBF comparing favorably to that for the current clinical reference bLV.",

keywords = "Arterial input, Cardiovascular magnetic resonance, Coronary artery disease, Myocardial blood flow, Myocardial ischemia, Myocardial perfusion quantification, Myocardial perfusion reserve",

author = "Xenios Milidonis and Russell Franks and Torben Schneider and Javier S{\'a}nchez-Gonz{\'a}lez and Sammut, {Eva C.} and Sven Plein and Amedeo Chiribiri",

note = "Funding Information: XM, RF and AC were funded by the European Metrology Programme for Innovation and Research (EMPIR) project 15HLT05 PerfusImaging, which is co-funded by the European Union{\textquoteright}s Horizon 2020 research and innovation programme and the EMPIR Participating States. XM, RF and SP were funded by the British Heart Foundation [TG/18/2/33768, PG/18/71/34009, CH/16/2/32089]. Further support was received by the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z], as well as the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust, the NIHR Cardiovascular MedTech Co-operative at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust and King{\textquoteright}s College London and supported by the NIHR Clinical Research Facility (CRF) at Guy{\textquoteright}s and St Thomas{\textquoteright}. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the DoH, the Wellcome Trust or the EPSRC. The funding bodies did not have a role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = dec,

doi = "10.1186/s12968-021-00733-4",

language = "English",

volume = "23",

journal = "Journal of Cardiovascular Magnetic Resonance",

issn = "1097-6647",

publisher = "BioMed Central",

number = "1",

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Milidonis, X, Franks, R, Schneider, T, Sánchez-González, J, Sammut, EC, Plein, S & Chiribiri, A 2021, 'Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification', Journal of Cardiovascular Magnetic Resonance, vol. 23, no. 1, 35. https://doi.org/10.1186/s12968-021-00733-4

TY - JOUR

T1 - Influence of the arterial input sampling location on the diagnostic accuracy of cardiovascular magnetic resonance stress myocardial perfusion quantification

AU - Milidonis, Xenios

AU - Franks, Russell

AU - Schneider, Torben

AU - Sánchez-González, Javier

AU - Sammut, Eva C.

AU - Plein, Sven

AU - Chiribiri, Amedeo

N1 - Funding Information: XM, RF and AC were funded by the European Metrology Programme for Innovation and Research (EMPIR) project 15HLT05 PerfusImaging, which is co-funded by the European Union’s Horizon 2020 research and innovation programme and the EMPIR Participating States. XM, RF and SP were funded by the British Heart Foundation [TG/18/2/33768, PG/18/71/34009, CH/16/2/32089]. Further support was received by the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z], as well as the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust, the NIHR Cardiovascular MedTech Co-operative at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London and supported by the NIHR Clinical Research Facility (CRF) at Guy’s and St Thomas’. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the DoH, the Wellcome Trust or the EPSRC. The funding bodies did not have a role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by cardiovascular magnetic resonance (CMR) perfusion requires sampling of the arterial input function (AIF). While variation in the AIF sampling location is known to impact quantification by CMR and positron emission tomography (PET) perfusion, there is no evidence to support the use of a specific location based on their diagnostic accuracy in the detection of coronary artery disease (CAD). This study aimed to evaluate the accuracy of stress MBF and MPR for different AIF sampling locations for the detection of abnormal myocardial perfusion with expert visual assessment as the reference. Methods: Twenty-five patients with suspected or known CAD underwent vasodilator stress-rest perfusion with a dual-sequence technique at 3T. A low-resolution slice was acquired in 3-chamber view to allow AIF sampling at five different locations: left atrium (LA), basal left ventricle (bLV), mid left ventricle (mLV), apical left ventricle (aLV) and aortic root (AoR). MBF and MPR were estimated at the segmental level using Fermi function-constrained deconvolution. Segments were scored as having normal or abnormal perfusion by visual assessment and the diagnostic accuracy of stress MBF and MPR for each location was evaluated using receiver operating characteristic curve analysis. Results: In both normal (300 out of 400, 75 %) and abnormal segments, rest MBF, stress MBF and MPR were significantly different across AIF sampling locations (p < 0.001). Stress MBF for the AoR (normal: 2.42 (2.15–2.84) mL/g/min; abnormal: 1.71 (1.28–1.98) mL/g/min) had the highest diagnostic accuracy (sensitivity 80 %, specificity 85 %, area under the curve 0.90; p < 0.001 versus stress MBF for all other locations including bLV: normal: 2.78 (2.39–3.14) mL/g/min; abnormal: 2.22 (1.83–2.48) mL/g/min; sensitivity 91 %, specificity 63 %, area under the curve 0.81) and performed better than MPR for the LV locations (p < 0.01). MPR for the AoR (normal: 2.43 (1.95–3.14); abnormal: 1.58 (1.34–1.90)) was not superior to MPR for the bLV (normal: 2.59 (2.04–3.20); abnormal: 1.69 (1.36–2.14); p = 0.717). Conclusions: The AIF sampling location has a significant impact on MBF and MPR estimates by CMR perfusion, with AoR-based stress MBF comparing favorably to that for the current clinical reference bLV.

AB - Background: Quantification of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) by cardiovascular magnetic resonance (CMR) perfusion requires sampling of the arterial input function (AIF). While variation in the AIF sampling location is known to impact quantification by CMR and positron emission tomography (PET) perfusion, there is no evidence to support the use of a specific location based on their diagnostic accuracy in the detection of coronary artery disease (CAD). This study aimed to evaluate the accuracy of stress MBF and MPR for different AIF sampling locations for the detection of abnormal myocardial perfusion with expert visual assessment as the reference. Methods: Twenty-five patients with suspected or known CAD underwent vasodilator stress-rest perfusion with a dual-sequence technique at 3T. A low-resolution slice was acquired in 3-chamber view to allow AIF sampling at five different locations: left atrium (LA), basal left ventricle (bLV), mid left ventricle (mLV), apical left ventricle (aLV) and aortic root (AoR). MBF and MPR were estimated at the segmental level using Fermi function-constrained deconvolution. Segments were scored as having normal or abnormal perfusion by visual assessment and the diagnostic accuracy of stress MBF and MPR for each location was evaluated using receiver operating characteristic curve analysis. Results: In both normal (300 out of 400, 75 %) and abnormal segments, rest MBF, stress MBF and MPR were significantly different across AIF sampling locations (p < 0.001). Stress MBF for the AoR (normal: 2.42 (2.15–2.84) mL/g/min; abnormal: 1.71 (1.28–1.98) mL/g/min) had the highest diagnostic accuracy (sensitivity 80 %, specificity 85 %, area under the curve 0.90; p < 0.001 versus stress MBF for all other locations including bLV: normal: 2.78 (2.39–3.14) mL/g/min; abnormal: 2.22 (1.83–2.48) mL/g/min; sensitivity 91 %, specificity 63 %, area under the curve 0.81) and performed better than MPR for the LV locations (p < 0.01). MPR for the AoR (normal: 2.43 (1.95–3.14); abnormal: 1.58 (1.34–1.90)) was not superior to MPR for the bLV (normal: 2.59 (2.04–3.20); abnormal: 1.69 (1.36–2.14); p = 0.717). Conclusions: The AIF sampling location has a significant impact on MBF and MPR estimates by CMR perfusion, with AoR-based stress MBF comparing favorably to that for the current clinical reference bLV.

KW - Arterial input

KW - Cardiovascular magnetic resonance

KW - Coronary artery disease

KW - Myocardial blood flow

KW - Myocardial ischemia

KW - Myocardial perfusion quantification

KW - Myocardial perfusion reserve

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U2 - 10.1186/s12968-021-00733-4

DO - 10.1186/s12968-021-00733-4

M3 - Article

C2 - 33775247

AN - SCOPUS:85103578999

SN - 1097-6647

VL - 23

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

IS - 1

M1 - 35

ER -