Comparison of dual-bolus versus dual-sequence techniques for determining myocardial blood flow and myocardial perfusion reserve by cardiac magnetic resonance stress perfusion: From the Automated Quantitative analysis of myocardial perfusion cardiac Magnetic Resonance Consortium.

Background: Quantitative stress cardiac magnetic resonance (CMR) can be performed using the dual-sequence (DS) technique or dual-bolus (DB) method. It is unknown if DS and DB produce similar results for myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). The study objective is to investigate if there are any differences between DB- and DS-derived MBF and MPR.
Methods: Retrospective observational study with 168 patients who underwent stress CMR. DB and DS methods were simultaneously performed on each patient on the same day. Global and segmental stress MBF and rest MBF values were collected.
Results: Using Bland-Altman analysis, segmental and global stress MBF values were higher in DB than DS (0.22 ± 0.60 mL/g/min, p < 0.001 and 0.20 ± 0.48 mL/g/min, p = 0.005, respectively) with strong correlation (r = 0.81, p < 0.001 for segmental and r = 0.82, p < 0.001 for global). In rest MBF, segmental and global DB values were higher than by DS (0.15 ± 0.51 mL/g/min, p < 0.001 and 0.14 ± 0.36 mL/g/min, p = 0.011, respectively) with strong correlation (r = 0.81, p < 0.001 and r = 0.77, p < 0.001). Mean difference between MPR by DB and DS was -0.02 ± 0.68 mL/g/min (p = 0.758) for segmental values and -0.01 ± 0.49 mL/g/min (p = 0.773) for global values. MPR values correlated strongly as well in both segmental and global, both (r = 0.74, p < 0.001) and (r = 0.75, p < 0.001), respectively.
Conclusion: There is a very good correlation between DB- and DS-derived MBF and MPR values. However, there are significant differences between DB- and DS-derived global stress and rest MBF. While MPR values did not show statistically significant differences between DB and DS methods.
Competing Interests: Declaration of competing interests The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ming-Yen Ng reports a relationship with Bayer AG that includes funding grants and speaking and lecture fees. Ming-Yen Ng reports a relationship with GE Healthcare that includes funding grants and speaking and lecture fees. Ming-Yen Ng reports a relationship with Circle Cardiovascular Imaging Inc. that includes funding grants and speaking and lecture fees. Ming-Yen Ng reports a relationship with Boerhinger Ingelheim that includes speaking and lecture fees. Ming-Yen Ng reports a relationship with Lode B.V. that includes funding grants. Ming-Yen Ng reports a relationship with Arterys Inc. that includes funding grants. Ming-Yen Ng reports a relationship with TeraRecon Inc. that includes funding grants. Associate Editor of JCMR - Ming-Yen Ng and Amit Patel; Associate Editor of JCCT - Ming-Yen Ng. Haonan Wang and Martin Janich are employees of GE HealthCare. Amit Patel has received research grants from GE Healthcare and research support from CircleCVI, Neosoft, and Siemens Healthineers. Mitchel Benovoy is the Chief Executive Officer of Area19 Medical, the Chief Executive Officer of ViTAA Medical Solutions, and a Member of The Board of Advisors at Yunu, Inc. Andrew E Arai has received royalty payments from Circle CVI. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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