Cardiovascular Magnetic Resonance Guided Revascularisation

Student thesis: Doctoral ThesisDoctor of Philosophy


Coronary revascularisation is a key component of the management of patients with coronary artery disease (CAD). The importance of combining functional with anatomic information to select appropriate patients is increasingly recognised. Established Cardiovascular Magnetic Resonance (CMR) techniques already provide much of the relevant functional information and the absence of ionising radiation makes CMR ideal for serial examinations. However, new CMR techniques continue to emerge, and require appropriate clinical evaluation.

This thesis comprises a series of clinical studies developing and evaluating techniques for guiding revascularisation:
i. Comparison of a high-resolution k-t accelerated perfusion sequence with a standard sequence.
ii. Validation of CMR quantification of absolute myocardial perfusion using the high-resolution sequence against PET.
iii. Investigation of the relationship between an angiographic score (BCIS-1 Jeopardy score) and CMR estimations of CAD burden.
iv. Determination of the inter-study reproducibility of perfusion imaging and strain analysis with CMR feature tracking (CMR-FT).
v. Evaluation of a novel scar imaging technique using a dual-inversion recovery (dual-IR) pre-pulse for the first-time in patients.
vi. The feasibility of combined CMR and coronary intervention in a hybrid laboratory.

The main findings for each compnent were:
i. Perfusion imaging with the k-t accelerated sequence resulted in significantly improved image quality, signal and contrast to noise ratios and a reduction in dark rim artefacts compared to the standard sequence.
ii. There was good correlation between quantitative myocardial perfusion reserve (MPR) derived from CPR and PET. CMR and PET-derived MPR were both comparable and accurate for the detection of CAD. However, absolute perfusion values from both modalities were only weakly correlated.
iii. The correlation between the BCIS-1 Jeopardy score and CMR ischaemic burden was good and the score predicted a prognostically important ischaemic threshold of 12% with high specificity. 
iv. The inter-study reproducibility of quantitative myocardial perfusion and CMR-FT was reasonable and better for global rather than regional measures. There was no detectable variation in perfusion or strain during the day.
v. The dual-IR sequence improved scar imaging compared to the IR technique.
vi. Combined CMR and interventional coronary procedures were successful and well tolerated.

Quantitative analysis of perfusion is an exciting prospect with considerable potential and has demonstrated clinically utility, however, its application remains challenging. Novel scar and strain imaging techniques have also shown promising results. Further method refinement and appropriate clinical studies should allow the full potential of these tools for guiding  revascularisation to be realised.

Date of Award1 Dec 2012
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorEike Nagel (Supervisor) & Divaka Perera (Supervisor)

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