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Methods This was a retrospective study using a 128 patient subsample of patients, selected from the CE-MARC study such that the distribution of risk factors and disease status within the sample was representative of the full study population. Both visual and quantitative analysis were carried out using the AHA standardised 16 segment model. Visual analysis was part of the original CE-MARC study and was performed by 2 expert reviewers in consensus. To obtain qMBF estimates, manual contouring of the myocardium was carried out and individual qMBF estimates were obtained for each AHA segment using Fermi-constrained deconvolution. The arterial input function was taken from the left ventricular blood pool of the basal slice. Myocardial perfusion reserve values were calculated on a segment by segment basis by dividing the stress by the rest qMBF. The reference standard for myocardial ischaemia was a quantitative coronary X-ray angiogram (QCA) score of ≥70% in any of the coronary territories, or ≥50% in the left main stem. Diagnostic performance was calculated using receiver operator characteristic (ROC) curve analysis. For visual analysis the summed score from all AHA segments was used as the diagnostic measure. For quantitative analysis the minimum MPR value from the AHA segments was used. A DeLong, DeLong, ClarkePearson analysis was performed to test for a statistically significant difference in the area under the curve (AUC) values between visual and quantitative analysis.

Quantitative myocardial perfusion performs as well as visual analysis in diagnosing myocardial ischaemia: a CE-MARC sub-study