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Rofo 2003; 175(10): 1355-1362
DOI: 10.1055/s-2003-42888
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© Georg Thieme Verlag Stuttgart · New York

Multislice TrueFISP-MR-Bildgebung zur Erkennung stressinduzierter myokardialer Funktionsstörungen bei koronarer Herzerkrankung

Multislice TrueFISP-MR Imaging for Identifying Stress-Induced Myocardial Functional Disturbances in Coronary Heart DiseaseU.  Kramer1 , M.  Fenchel1 , U.  Helber2 , A.  Kraft1 , N.  I.  Stauder1 , A.  Franow2 , C.  D.  Claussen1 , S.  Miller1
  • 1Radiologische Klinik, Abteilung Radiologische Diagnostik
  • 2Medizinische Klinik, Abteilung für Kardiologie und Nephrologie, Eberhard-Karls-Universität Tübingen
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Publication Date:
13 October 2003 (online)

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Zusammenfassung

Einleitung: Zielsetzung war die Erprobung und Bestimmung der diagnostischen Aussagekraft neuer Multislice-Sequenzen zur Bestimmung linksventrikulärer Funktionsparameter sowie Detektion stressinduzierter Wandbewegungsstörungen bei Patienten mit koronarer Herzerkrankung. Material und Methoden: Es wurden 15 Patienten (Durchschnittsalter 57,7 Jahre) mit koronarangiographisch gesicherter KHK an einem 1,5 T-Ganzkörpertomographen in Ruhe und unter pharmakologisch induziertem Stress (Dipyridamol, 0,56 mg/kg Körpergewicht) untersucht. Im Rahmen der Fragestellung wurde ein Sequenzvergleich einer zeitlich und örtlich hochaufgelösten TrueFISP-2D-Einzelschicht-Sequenz (TR 3,2 ms, TE 1,6 ms, Schichtdicke 5 mm, Zeitauflösung 45 ms) gegenüber einer Multislice-Sequenz (TR 2,3 ms, TE 1,15 ms, Schichtdicke 10 mm, Zeitauflösung 77 ms) durchgeführt. Ergebnisse: Während regionale Wandbewegungsstörungen in beiden Sequenzen mit einer hohen Korrelation (r = 0,95) nachgewiesen werden konnten, so zeigten die Ergebnisse der Ventrikelvolumetrie eine hohe Variabilität. Endsystolische Volumina wurden mittels Multislice-Sequenz (MW 78 ml, + 5,8 %) im Vergleich zur Referenzsequenz (MW 74 ml) systematisch überschätzt, die EF falsch niedrig (MW 40 %, - 11,3 %) bestimmt. Diskussion: Großer Vorteil schneller Multislice-Sequenzen ist der Zeitgewinn bei guter diagnostischer Aussagekraft in der Detektion von stressinduzierten Wandbewegungsstörungen. Quantitative Aussagen zu linksventrikulären Funktionsparametern sind im Vergleich zu etablierten Referenzverfahren nur bedingt zu verwerten.

Abstract

Purpose: This study assesses the left ventricular function using a new multislice cine sequence and determines the diagnostic accuracy of stress-induced wall motion abnormalities in patients with coronary artery disease (CAD). Materials and Methods: 15 patients (mean age 57.7 years) with angiographically proven CAD were examined on a 1.5 T whole body system (Magnetom Sonata, Siemens, Erlangen) at rest and during dipyridamole-induced (0.56 mg/kg body weight) stress. Left ventricular function was determined using a multislice (steady-state) sequence (TR 2.3 ms, TE 1.15 ms, slice thickness 10 mm, temporal resolution 77 ms) as well as a standard single-slice true FISP 2D sequence (TR 3.2 ms, TE 1.6 ms, slice thickness 5 mm, temporal resolution 45 ms) as reference. Results: Both cine sequences provide high sensitivity and excellent correlation (r = 0.95) with angiographic findings for the detection of regional wall motion abnormalities. However, the measurement of functional parameters yielded significant differences. End-systolic left ventricular volumes (ESV) were systematically overestimated in the multislice images (mean 78 ml, + 5.8 %) compared with the reference single-slice images (mean 74 ml) (p < 0.05). This resulted in underestimation of the ejection fraction with multislice images (mean 40 %, - 11.3 %) compared with single-slice images (mean 46 %) (p < 0.05). Conclusion: The multislice sequence results in a substantial reduction of imaging time and breath-hold periods necessary to cover the left ventricle for functional assessment. The multislice sequence yields adequate images, especially for qualitative determination of wall motion abnormalities. Due to the reduced spatial and temporal resolution of the multi-slice sequence, however, some uncertainty concerning the functional parameters has to be taken into account.

Key words

Magnetic resonance (MR) - heart - MR - myocardial function - ischemia - multislice-sequences

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Dr. med. Ulrich Kramer

Universitätsklinikum Tübingen Abteilung Radiologische Diagnostik

Hoppe-Seyler-Straße 3

72076 Tübingen

Phone: + 49-7071-2985837

Fax: + 49-7071-295694

Email: ulrich.kramer@med.uni-tuebingen.de

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