Single session of MRI coronary angiography and myocardial perfusion

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Slide 1 :

Single Session of MR Coronary Angiography and Myocardial Perfusion Imaging Using a New Blood Pool Compound B-22956 (Gadocoletic Acid): Initial Experience in a Porcine Model of Coronary Artery Disease Jie Zheng, PhD Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, MO Zheng J et al, Investigative Radiology 2005;40:604-613

Slide 2 :

POSITIVE NON DIAGNOSTIC POSITIVE NON DIAGNOSTIC Diagnostic Decision Tree for Coronary Artery Disease ~ 4.4 m procedures/y Stress ECG Ultrasound $ 400.- rule out CAD medication Stress Perfusion Imaging Nuclear Medicine rule out CAD medication ~ 2.2 m procedures/y X-Ray Coronary Angiography or IVUS $ 300.- ~ 13 m procedures/y Radiation Invasive

Slide 3 :

Advantages of Cardiac MRI No radiation and minimal invasiveness (IV injection) 3-dimensional anatomic images (3D coronary artery and myocardial imaging) Comprehensive functional imaging - Myocardial mechanical work - Myocardial perfusion - Myocardial oxygenation - Myocardial Viability

Slide 4 :

Challenges of Cardiac MRI Prone to cardiac and respiratory motions Low signal-to-noise ratio Low spatial resolution relative to motionless organs (brain, kidney, etc) Intravascular or blood-pool contrast agents can potentially overcome these limitations!

Slide 5 :

New Experimental Contrast for MR Coronary Angiography: B-22956/1 Low molecular weight Gd chelate with very high affinity for serum proteins : Apparent longitudinal relaxivity (0.5 mM in Seronorm®) : Binding (0.5 mM) to HSA 0.6 mM 94 % (80 %)* Binding (0.5 mM) to PSA 0.6 mM 90 % (56 %)* Binding (0.5 mM) to MSA 0.6 mM 92 % (81 %)* * data in parenthesis are for MS-325, a protein binding contrast agent undergoing Clinical Trials and FDA approval r1 27 mM-1 ·s -1 (35 mM-1 ·s -1)*

Slide 6 :

MPR Images (Siemens Symphony 1.5T) after 0.125 mmol/kg Injection of B-22956/1 [Res. : 0.7 ? 0.7 ? 0.7 mm3] 1 min postcontrast 33 min postcontrast 17 min postcontrast RCA

Slide 7 :

RCA LAD LCx Res. : 1.0 ? 1.0 ? 2.0 (1.0) mm3 Volume Rendering 3D MR Coronary Angiography in Pigs after B-22956/1 (0.1 mmol/kg b.w.) RCA

Slide 8 :

B-22956/1 0.02 mmol/kg 2.7 s 6.4 s 9.1 s 16.4 s 20.0 s 23.6 s Conventional Gadolinium (FDA approved MRI contrast agent)® 0.04 mmol/kg 2.4 s 5.6 s 8.0 s 14.4 s 17.6 s 20.8 s Myocardial Perfusion Imaging in Pig @ 1.5T (IR-True FISP TR/TE/a: 3.5/1.8/70°)

Slide 9 :

Materials and Methods Six Yucatan mini-swine (mean weight = 18 kg) Coronary balloon angioplasty injury and atherogenic diet feeding atherosclerotic plaques in 2 or 3 coronary arteries X-ray angiography prior to MR scans MR precontrast coronary imaging Injection of 0.1 or 0.15 mmol/kg B-22956/1 (Bracco) MR postcontrast scans (breath-holds (BH) and navigator-echo gated imaging (NAV))

Slide 10 :

X-ray Pig 2: LCx, Mild Stenosis < 50% LCx LAD

Slide 11 :

Pig 2: RCA, Moderate Stenosis 50-70% X-ray Post-BH Post-NAV 50-70%

Slide :

Slide 13 :

Pig 1: RCA, Perfusion High Grade Stenosis > 95% Low Perfusion in RCA Normal Perfusion in LAD

Slide 14 :

Breath-hold and high-resolution navigator-echo gated scans could repeat after the contrast injection MR Coronary Angiography results qualitatively confirmed x-ray findings in terms of stenosis degree and locations Functional assessment of myocardial perfusion simultaneously Results

Slide 15 :

Conclusions Availability of B-22956/1 will greatly facilitate the successful development of Magnetic Resonance Coronary Angiography and quantification of myocardial perfusion Clinical Trials are warranted to further assess the potential of this contrast agent

Management of Non ST...

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	zhengj@mir.wustl.edu 5 Years ago.



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