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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

	zhengj@mir.wustl.edu 1 Years ago. Category: Radiology

Tags:	Radiology

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