Cardiac MRI for myocardial stress perfusion and viability imaging in patients with known or suspected coronary artery disease

Abstract

Cardiac MRI (CMR) uses a standard MRI system, with or without specialised cardiac coils, and specialised software for quantitative analysis. The magnetic field strength used for CMR is usually either 1.5 or 3.0 teslas (T) and the images obtained are interpreted by either a qualified cardiologist or radiologist. Stress perfusion CMR (SP-CMR) detects damaged or ischaemic myocardium, which manifests as perfusion deficits or low signal areas detected during a first-pass perfusion sequence using a gadolinium-based contrast agent (Gotschy et al. 2014). These images are usually compared with perfusion images taken at rest. Viability imaging via delayed contrast-enhanced CMR, or late gadolinium enhancement (LGE), also uses gadolinium-based contrast agents to define the extent of irreversibly damaged (necrotic or scarred) myocardium (Medical Advisory Secretariat 2010e; Woodard et al. 2006). CMR for CAD is not currently covered by private health insurance and private patients who utilise CMR services are required to pay the full cost of the procedure. This contracted assessment of cardiac MRI (magnetic resonance imaging) for myocardial stress perfusion and viability imaging in patients with known or suspected coronary artery disease (CAD) addresses most of the PICO1 elements that were pre-specified in the Protocol that was ratified by the Protocol Advisory Subcommittee (PASC) or the Medical Services Advisory Committee (MSAC) Executive.