Strain‐encoded cardiac MR during high‐dose dobutamine stress testing: Comparison to cine imaging and to myocardial tagging

Abstract Purpose To investigate regional strain response during high‐dose dobutamine stress cardiac magnetic resonance imaging (DS‐CMR) using myocardial tagging and Strain‐Encoded MR (SENC). Materials and Methods Stress induced ischemia was assessed by wall motion analysis, by tagged CMR and by SENC in 65 patients with suspected or known CAD who underwent DS‐CMR in a clinical 1.5 Tesla scanner. Coronary angiography deemed as the standard reference for the presence or absence of CAD (≥50% diameter stenosis) in all patients. Results SENC and conventional tagging detected abnormal strain response in six and five additional patients, respectively, who were missed by cine images and proved to have CAD by angiography ( P < 0.05 for SENC versus cine, P = 0.06 for tagging versus cine and p = NS for SENC versus tagging). On a per‐vessel level, wall motion analysis on cine images showed high specificity (95%) but moderate sensitivity (70%) for the detection of CAD. Tagging and SENC yielded significantly higher sensitivity of 81% and 89%, respectively ( P < 0.05 for tagging and P < 0.01 for SENC versus wall motion analysis, and p = NS for SENC versus tagging), while specificity was equally high (96% and 94%, respectively, P = NS for all). Conclusion Both the direct color‐coded visualization of strain on CMR images and the generation of additional visual markers within the myocardium with tagged CMR represent useful adjuncts for DS‐CMR, which may provide incremental value for the detection of CAD in humans. J. Magn. Reson. Imaging 2009;29:1053–1061. © 2009 Wiley‐Liss, Inc.