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. 2011 Dec;261(3):771-8.
doi: 10.1148/radiol.11110573. Epub 2011 Aug 26.

Noninvasive evaluation of coronary distensibility in older adults: a feasibility study with MR angiography

Kai Lin  1 , Donald M Lloyd-Jones, Ying Liu, Xiaoming Bi, Debiao Li, James C Carr
Affiliations

Noninvasive evaluation of coronary distensibility in older adults: a feasibility study with MR angiography

Kai Lin et al. Radiology. 2011 Dec.

Abstract

Purpose: To assess the feasibility of using magnetic resonance (MR) angiography to noninvasively measure the coronary distensibility index (CDI) in older adults.

Materials and methods: This study was approved by the institutional review board and was compliant with HIPAA. Informed consent was obtained from all participants. Three-dimensional MR angiography was performed in 23 patients with type 2 diabetes mellitus (DM) (mean age, 72.9 years ± 5.8 [standard deviation]; age range, 65-84 years; 12 men, 11 women) and 50 healthy aging control subjects (mean age, 73.1 years ± 5.6; age range, 64-84 years; 28 men, 22 women). Imaging data were acquired in the rest periods of cardiac motion identified during end systole and middiastole. For imaging data with different acquisition windows, cross-sectional coronary planes were reconstructed and matched for the same anatomy according to coronary landmarks. The CDI, defined as [(lumen area at systole--lumen area at diastole)/(lumen area at diastole × pulse pressure)] × 1000, was compared between patients with DM and control subjects by using the Student t test. With the same protocol, CDIs were calculated in 10 randomly selected subjects by two independent readers. In addition, MR angiography (in systole and diastole) was repeated in those 10 subjects after repositioning.

Results: CDIs were measured in 43 coronary segments of patients with DM and in 124 coronary segments of control subjects. The mean CDI in patients with DM was significantly lower than that in control subjects (2.79 mm Hg(-1) ± 2.12 vs 9.14 mm Hg(-1) ± 5.87, respectively; P < .001). CDI measurements showed good intraobserver (r = 0.914), interobserver (r = 0.820), and imaging-repeat imaging agreements (r = 0.811).

Conclusion: Coronary MR angiography is a reproducible and repeatable noninvasive method for detecting significant differences in coronary distensibility between patients with DM and healthy aging control subjects.

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Figures

Figure 1a:
Figure 1a:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 1b:
Figure 1b:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 1c:
Figure 1c:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 1d:
Figure 1d:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 1e:
Figure 1e:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 1f:
Figure 1f:
Images in a 73-year-old male control subject. Peripheral blood pressure was 130/70 mm Hg (pulse pressure = 60 mm Hg). (a) Longitudinal view of RCA in middiastole. (b) Longitudinal view of RCA in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 7.61 mm2). (f) Zoomed view during systole shows lumen contour (area, 15.05 mm2). CDI = [(15.05 − 7.61)/(7.61/60)] × 1000 = 16.29 mm Hg−1. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2a:
Figure 2a:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2b:
Figure 2b:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2c:
Figure 2c:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2d:
Figure 2d:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2e:
Figure 2e:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 2f:
Figure 2f:
Images in an 84-year-old man with an 8-year history of type 2 DM. Peripheral blood pressure was 135/70 mm Hg (pulse pressure = 65 mm Hg). (a) Longitudinal view of LM artery in middiastole. (b) Longitudinal view of LM artery in end systole. (c) Transverse view of lumen in middiastole. (d) Transverse view of lumen in end systole. (e) Zoomed view during diastole shows lumen contour (area, 13.74 mm2). (f) Zoomed view during systole shows lumen contour (area, 16.35 mm2). CDI = [(16.35 − 13.74)/(13.74/65)] × 1000 = 2.92 mm Hg−1. LV = left ventricle. Lines in a and b represent locations of transverse views of vessel on its longitudinal view.
Figure 3a:
Figure 3a:
Repeatability and reproducibility of CDI measurements with MR angiography. (a) Bland-Altman plot shows excellent intraobserver agreement between CDI measurements for reader 1 (r = 0.914), with low variability of CDI measurements. (b) Bland-Altman plot shows good interobserver agreement of CDI measurements between readers 1 and 2 (r = 0.820), with mild dispersion of CDI measurements. (c) Bland-Altman plot shows good imaging–repeat imaging agreement between CDI measurements for reader 1 (r = 0.811), with mild discrepancy of CDI measurements. Data points that appear outside the 1 standard deviation (SD) region may be due to the effect of signal loss on coronary lumen measurements.
Figure 3b:
Figure 3b:
Repeatability and reproducibility of CDI measurements with MR angiography. (a) Bland-Altman plot shows excellent intraobserver agreement between CDI measurements for reader 1 (r = 0.914), with low variability of CDI measurements. (b) Bland-Altman plot shows good interobserver agreement of CDI measurements between readers 1 and 2 (r = 0.820), with mild dispersion of CDI measurements. (c) Bland-Altman plot shows good imaging–repeat imaging agreement between CDI measurements for reader 1 (r = 0.811), with mild discrepancy of CDI measurements. Data points that appear outside the 1 standard deviation (SD) region may be due to the effect of signal loss on coronary lumen measurements.
Figure 3c:
Figure 3c:
Repeatability and reproducibility of CDI measurements with MR angiography. (a) Bland-Altman plot shows excellent intraobserver agreement between CDI measurements for reader 1 (r = 0.914), with low variability of CDI measurements. (b) Bland-Altman plot shows good interobserver agreement of CDI measurements between readers 1 and 2 (r = 0.820), with mild dispersion of CDI measurements. (c) Bland-Altman plot shows good imaging–repeat imaging agreement between CDI measurements for reader 1 (r = 0.811), with mild discrepancy of CDI measurements. Data points that appear outside the 1 standard deviation (SD) region may be due to the effect of signal loss on coronary lumen measurements.
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