RESUMO
BACKGROUND: GadaCAD2 was 1 of 2 international, multicenter, prospective, Phase 3 clinical trials that led to U.S. Food and Drug Administration approval of gadobutrol to assess myocardial perfusion and late gadolinium enhancement (LGE) in adults with known or suspected coronary artery disease (CAD). OBJECTIVES: A prespecified secondary objective was to determine if stress perfusion cardiovascular magnetic resonance (CMR) was noninferior to single-photon emission computed tomography (SPECT) for detecting significant CAD and for excluding significant CAD. METHODS: Participants with known or suspected CAD underwent a research rest and stress perfusion CMR that was compared with a gated SPECT performed using standard clinical protocols. For CMR, adenosine or regadenoson served as vasodilators. The total dose of gadobutrol was 0.1 mmol/kg body weight. The standard of reference was a 70% stenosis defined by quantitative coronary angiography (QCA). A negative coronary computed tomography angiography could exclude CAD. Analysis was per patient. CMR, SPECT, and QCA were evaluated by independent central core lab readers blinded to clinical information. RESULTS: Participants were predominantly male (61.4% male; mean age 58.9 ± 10.2 years) and were recruited from the United States (75.0%), Australia (14.7%), Singapore (5.7%), and Canada (4.6%). The prevalence of significant CAD was 24.5% (n = 72 of 294). Stress perfusion CMR was statistically superior to gated SPECT for specificity (P = 0.002), area under the receiver operating characteristic curve (P < 0.001), accuracy (P = 0.003), positive predictive value (P < 0.001), and negative predictive value (P = 0.041). The sensitivity of CMR for a 70% QCA stenosis was noninferior and nonsuperior to gated SPECT. CONCLUSIONS: Vasodilator stress perfusion CMR, as performed with gadobutrol 0.1 mmol/kg body weight, had superior diagnostic accuracy for diagnosis and exclusion of significant CAD vs gated SPECT.
Assuntos
Doença da Artéria Coronariana , Imagem de Perfusão do Miocárdio , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peso Corporal , Constrição Patológica , Meios de Contraste , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Gadolínio , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Perfusão , Valor Preditivo dos Testes , Estudos Prospectivos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , VasodilatadoresRESUMO
The purpose of this study was to describe the methodology necessary for simultaneous recording of intracranial EEG (ICEEG) and magnetoencephalography (MEG) and to assess the sensitivity of whole-head MEG versus depth electrode EEG in the detection and localization of epileptic spikes. Interictal MEG and depth electrode activities from the temporal mesial and occipital lobes were simultaneously recorded from four candidates for epilepsy surgery. Implanted depth electrodes identified neocortical and mesial structures of ictal onset. Interictal spikes detected by these same depth electrodes were compared with simultaneous MEG events. MEG detections of ICEEG spikes, ICEEG versus MEG spike amplitudes, number of ICEEG contacts involved in the spike, and anatomic locations of MEG equivalent current dipoles were analyzed. MEG detected and localized 95% of the neocortical spikes, but only 25% to 60% of spikes from mesial structures. Mesial temporal spikes resulted in lower MEG spike amplitudes, when compared with neocortical spikes. Equivalent current dipoles of MEG spikes localized to the ictal onset zones in all four patients. MEG can detect and localize interictal epileptiform spikes that are recorded from depth electrodes in both neocortical and mesial structures, despite the lesser amplitude of spikes of mesial origin.
Assuntos
Encéfalo/fisiopatologia , Eletroencefalografia/métodos , Epilepsia/fisiopatologia , Magnetoencefalografia/métodos , Adolescente , Criança , Eletrodos Implantados , Feminino , Humanos , Masculino , Sensibilidade e EspecificidadeRESUMO
La localización del inicio de las crisis es un factor importante para la evaluación prequirúrgica de la epilepsia. En este trabajo se describe la localización del inicio de una crisis registrada mediante magnetoencefalografía (MEG) en un niño de 12 años que presenta crisis parciales complejas farmacorresistentes. La RM muestra una lesión de 20mm de diámetro en el hipocampo izquierdo. EEG de superficie con ondas theta temporales izquierdas. Registro MEG interictal con punta-onda aislada posterior e inferior a la lesión de la RM. Registro MEG ictal con punta-onda (2 Hz). La localización de los dipolos indica el inicio de la crisis en la circunvolución temporal inferior en la misma localización que la actividad interictal MEG. Esta actividad ictal se propaga bilateralmente a áreas frontales. El registro corticográfico intraquirúrgico confirma los resultados de la localización interictal mediante MEG.