Anterior cruciate ligament injury should not be considered a contraindication for medial unicompartmental knee arthroplasty: Finite element analysis.

PURPOSE: The research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA. METHODS: Based on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure. RESULTS: A total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05). CONCLUSION: This study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.

Photo-Induced Electron Transfer-Triggered Structure Deformation Promoting Near-Infrared Photothermal Conversion for Tumor Therapy.

Photothermal therapy (PTT) is a promising approach to cancer treatment. Heptamethine cyanine (Cy7) is an attractive photothermal reagent because of its large molar absorption coefficient, good biocompatibility, and absorption of near-infrared irradiation. However, the photothermal conversion efficiency (PCE) of Cy7 is limited without ingenious excitation-state regulation. In this study, the photothermal conversion ability of Cy7 is efficiently enhanced based on photo-induced electron transfer (PET)-triggered structural deformation. Three Cy7 derivatives, whose Cl is replaced by carbazole, phenoxazine, and phenothiazine at the meso-position (CZ-Cy7, PXZ-Cy7, and PTZ-Cy7), are presented as examples to demonstrate the regulation of the energy release of the excited states. Because the phenothiazine moiety exhibits an obvious PET-induced structural deformation in the excited state, which quenches the fluorescence and inhibits intersystem crossing of S1 →T1 , PTZ-Cy7 exhibits a PCE as high as 77.5%. As a control, only PET occurs in PXZ-Cy7, with a PCE of 43.5%. Furthermore, the PCE of CZ-Cy7 is only 13.0% because there is no PET process. Interestingly, PTZ-Cy7 self-assembles into homogeneous nanoparticles exhibiting passive tumor-targeting properties. This study provides a new strategy for excited-state regulation for photoacoustic imaging-guided PTT with high efficiency.

Predictive Value of Cardiac Magnetic Resonance for Left Ventricular Remodeling of Patients with Acute Anterior Myocardial Infarction.

Background: Heart failure is a serious complication resulting from left ventricular remodeling (LVR), especially in patients experiencing acute anterior myocardial infarction (AAMI). It is crucial to explore the predictive parameters for LVR following primary percutaneous coronary intervention (PPCI) in patients with AAMI. Methods: A total of 128 AAMI patients who were reperfused successfully by PPCI were enrolled sequentially from June 2018 to December 2019. Cardiovascular magnetic resonance (CMR) was performed at the early stage (<7 days) and after the 6-month follow-up. The patients were divided into LVR and non-LVR groups according to the increase of left ventricular end diastolic volume (LVEDV) measured by the second cardiac magnetic resonance examination ≥20% from baseline. (3) Results: The left ventricular ejection fraction (LVEF), the global longitudinal strain (GLS), the peak circumferential strain in infarcted segments, and the infarct size (IS) remained significantly different in the multivariate logistic regression analysis (all p < 0.05). The area under the receiver operating characteristic curve of Model 1, wherein the GLS was added to the LVEF, was 0.832 (95% CI 0.758−0.907, p < 0.001). The C-statistics for Model 2, which included the infarct-related regional parameters (IS and the peak circumferential strain in infarcted segments)was 0.917 (95% CI 0.870−0.965, p < 0.001). Model 2 was statistically superior to Model 1 in predicting LVR (IDI: 0.190, p = 0.002). (4) Conclusions: Both the global and regional CMR parameters were valuable in predicting LVR in patients with AAMI following the PPCI. The local parameters of the infarct zones were superior to those of the global ones.

Strain parameters for predicting the prognosis of non-ischemic dilated cardiomyopathy using cardiovascular magnetic resonance tissue feature tracking.

BACKGROUND: A considerable number of non-ischemic dilated cardiomyopathy (NDCM) patients had been found to have normalized left ventricular (LV) size and systolic function with tailored medical treatments. Accordingly, we aimed to evaluate if strain parameters assessed by cardiovascular magnetic resonance (CMR) feature tracking (FT) analysis could predict the NDCM recovery. METHODS: 79 newly diagnosed NDCM patients who underwent baseline and follow-up CMR scans were enrolled. Recovery was defined as a current normalized LV size and systolic function evaluated by CMR. RESULTS: Among 79 patients, 21 (27%) were confirmed recovered at a median follow-up of 36 months. Recovered patients presented with faster heart rates (HR) and larger body surface area (BSA) at baseline (P < 0.05). Compared to unrecovered patients, recovered pateints had a higher LV apical radial strain divided by basal radial strain (RSapi/bas) and a lower standard deviation of time to peak radial strain in 16 segments of the LV (SD16-TTPRS). According to a multivariate logistic regression model, RSapi/bas (P = 0.035) and SD16-TTPRS (P = 0.012) resulted as significant predictors for differentiation of recovered from unrecovered patients. The sensitivity and specificity of RSapi/bas and SD16-TTPRS for predicting recovered conditions were 76%, 67%, and 91%, 59%, with the area under the curve of 0.75 and 0.76, respectively. Further, Kaplan Meier survival analysis showed that patients with RSapi/bas ≥ 0.95% and SD16-FTPRS ≤ 111 ms had the highest recovery rate (65%, P = 0.027). CONCLUSIONS: RSapi/bas and CMR SD16-TTPRS may be used as non-invasive parameters for predicting LV recovery in NDCM. This finding may be beneficial for subsequent treatments and prognosis of NDCM patients. Registration number: ChiCTR-POC-17012586.

Tratamiento endovascular de aneurisma gigante de aorta abdominal / Endovascular exclusion for giant abdominal aortic aneurysm

No disponible

Repetitive ventricular tachycardia triggered by a giant benign cardiac lipomyoma.

Cardiac lipomyomas are tumors that may produce various signs and symptoms, including life threatening ventricular tachycardia (VT), often requiring surgical resection and/or catheter ablation. Here we report on a 35-year-old female patient with longstanding repetitive VT in the setting of a large cardiac lipomyoma. Diagnostic testing included non-invasive approaches including ECG, echocardiography and CMR. She then underwent electroanatomic mapping, which provided additional information. The patient ultimately underwent partial resection of the tumor. Postoperatively, long term ambulatory ECG showed VT suppression without anti-arrhythmic or catheter ablation for VT.

Ultraminiature and Flexible Sensor Based on Interior Corner Flow for Direct Pressure Sensing in Biofluids.

Conventional pressure sensing devices are well developed for either indirect evaluation or internal measuring of fluid pressure over millimeter scale. Whereas, specialized pressure sensors that can directly work in various liquid environments at micrometer scale remain challenging and rarely explored, but are of great importance in many biomedical applications. Here, pressure sensor technology that utilizes capillary action to self-assemble the pressure-sensitive element is introduced. Sophisticated control of capillary flow, tunable sensitivity to liquid pressure in various mediums, and multiple transduction modes are realized in a polymer device, which is also flexible (thickness of 8 µm), ultraminiature (effective volume of 18 × 100 × 580 µm3 ), and transparent, enabling the sensor to work in some extreme situations, such as in narrow inner spaces (e.g., a microchannel of 220 µm in width and 100 µm in height), or on the surface of small objects (e.g., a 380 µm diameter needle). Potential applications of this sensor include disposables for in vivo and short-term measurements.

Sensory-to-Category Transformation via Dynamic Reorganization of Ensemble Structures in Mouse Auditory Cortex.

The ability to group physical stimuli into behaviorally relevant categories is fundamental to perception and cognition. Despite a large body of work on stimulus categorization at the behavioral and cognitive levels, little is known about the underlying mechanisms at the neuronal level. Here, combining mouse auditory psychophysical behavior and in vivo two-photon imaging from the auditory cortex, we investigate how sensory-to-category transformation is implemented by cortical neurons during a stimulus categorization task. Distinct from responses during passive listening, many neurons exhibited emergent selectivity to stimuli near the category boundary during task performance, reshaping local tuning maps; other neurons became more selective to category membership of stimuli. At the population level, local cortical ensembles robustly encode category information and predict trial-by-trial decisions during task performance. Our data uncover a task-dependent dynamic reorganization of cortical response patterns serving as a neural mechanism for sensory-to-category transformation during perceptual decision-making.

The Value of Low-Dose Dynamic Myocardial Perfusion CT for Accurate Evaluation of Microvascular Obstruction in Patients With Acute Myocardial Infarction.

OBJECTIVE. The purpose of this study was to investigate the diagnostic performance of quantitative parameters generated from dynamic myocardial perfusion CT for assessment of acute myocardial infarction (AMI) and microvascular obstruction (MVO) using cardiac MRI as a reference standard. SUBJECTS AND METHODS. Patients who underwent successful reperfusion treatment within 1 week after AMI between January 1, 2018, and May 31, 2018, were prospectively enrolled. All patients were referred for cardiac MRI and dynamic myocardial perfusion CT on the same day. Various quantitative parameters and late iodine enhancement (LIE) were analyzed for the evaluation of AMI and MVO using cardiac MRI findings as a reference standard. RESULTS. Twenty-seven patients with 442 vascular segments were ultimately included in the analysis. The mean radiation doses ± SD for dynamic myocardial perfusion CT and LIE were 3.3 ± 1.1 mSv and 2.0 ± 0.6 mSv, respectively. Myocardial blood flow (MBF) was significantly lower in segments with MVO than in those without MVO and in reference segments (23.08 ± 7.95 mL/min/100 mL vs 44.60 ± 14.97 mL/min/100 mL and 75.07 ± 7.34 mL/min/100 mL; p < 0.001). According to ROC curve analysis, MBF had the largest AUC of all parameters for identifying AMI with and without MVO as determined by late gadolinium enhancement (LGE) (AUC = 0.941 and 0.996; p < 0.001). The diagnostic accuracy of MBF-based assessment for identifying MVO was 99.2%, which outperformed other quantitative parameters and LIE. We found good correlation between the AMI area and MVO area estimated by MBF and LGE (r = 0.95 and 0.99; p < 0.001). CONCLUSION. MBF derived from dynamic myocardial perfusion CT is accurate and outperforms other quantitative parameters and LIE in diagnosis of AMI and MVO. Area of AMI and MVO can also be accurately estimated using MBF.

Causal contributions of parietal cortex to perceptual decision-making during stimulus categorization.

The posterior parietal cortex (PPC) has been implicated in perceptual decision-making and categorization, but whether its activity plays a causal role remains controversial. Here we examined the population dynamics of PPC activity during an auditory-guided decision task in mice. We found that silencing of PPC activity impaired several aspects of decision-making. First, categorization of new, but not well-learned, stimuli was impaired. Second, re-categorization of previously experienced stimuli based on newly learned categories was also impaired. Third, the bias on behavioral choices created by preceding trials significantly increased. In vivo two-photon imaging of PPC activity during stimulus categorization revealed differential dynamics in representations of new stimuli and learned categories, consistent with rapid incorporation of new sensory information during categorization. At the circuit level, inactivation of PPC axonal projections to the auditory cortex also significantly reduced categorization performance. Thus, PPC circuits play a causal role in decision-making during stimulus categorization.

Myocardial Blood Flow Quantified by Low-Dose Dynamic CT Myocardial Perfusion Imaging Is Associated with Peak Troponin Level and Impaired Left Ventricle Function in Patients with ST-Elevated Myocardial Infarction.

OBJECTIVE: To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI). MATERIALS AND METHODS: Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark. RESULTS: The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = -0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = -0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001). CONCLUSION: MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.

Evaluation of elevated left ventricular end diastolic pressure in patients with preserved ejection fraction using cardiac magnetic resonance.

OBJECTIVES: This study aims to validate the reliability of cardiac magnetic resonance (CMR) parameters for estimating left ventricular end diastolic pressure (LVEDP) in heart failure patients with preserved ejection fraction (HFpEF) and compare their accuracy to conventional echocardiographic ones, with reference to left heart catheterisation. METHODS: Sixty patients with exertional dyspnoea (New York Heart Association function class II to III) were consecutively enrolled. CMR-derived time-volume curve and deformation parameters, conventional echocardiographic diastolic indices as well as LVEDP evaluated by left heart catheterisation were collected and analysed. RESULTS: Fifty-one patients, who accomplished all three examinations, were divided into HFpEF group and non-HFpEF group based on LVEDP measurements. Compared to the non-HFpEF group, CMR-derived time-volume curve showed lower peak filling rate adjusted for end diastolic volume (PFR/EDV, p = 0.027), longer time to peak filling rate (T-PFR, p < 0.001), and increased T-PFR in one cardiac cycle (%T-PFR, p < 0.001) in HFpEF group. In multivariable linear regression analysis, %T-PFR (ß = 0.372, p = 0.024), left ventricular global peak longitudinal diastolic strain rate (LDSR, ß = -0.471, p = 0.006), and E/e' (ß = 0.547, p = 0.001) were independently associated with invasively measured LVEDP. The sensitivity and specificity of E/e' and LDSR for predicting the elevated LVEDP were 76%, 92% and 76%, 89%, respectively. CONCLUSIONS: These findings suggest that CMR-derived time-volume curve and strain indices could predict HFpEF patients. Not only E/e' assessed by echocardiography but also the CMR-derived %T-PFR and LDSR correlated well with LVEDP. These non-invasive parameters were validated to evaluate the left ventricular diastolic function. KEY POINTS: • The abnormal time-volume curve revealed insufficient early diastole in HFpEF patients. • Non-invasive parameters including E/e', %T-PFR, and LDSR correlated well with LVEDP.

Image quality and diagnostic accuracy of coronary CT angiography derived from low-dose dynamic CT myocardial perfusion: a feasibility study with comparison to invasive coronary angiography.

OBJECTIVES: To investigate the diagnostic performance of coronary CT angiography derived from dynamic CT myocardial perfusion imaging (CCTACT-MPI) by third-generation dual-source CT with reference to invasive coronary angiography (ICA). MATERIALS AND METHODS: Patients with acute myocardial infarction and those who received successful reperfusion treatment were prospectively enrolled. Emergent ICA findings were used as the reference standard to assess the diagnostic performance of CCTACT-MPI for detection of significant coronary stenosis (diameter stenosis ≥ 50%). The radiation dose as well as image quality of CCTACT-MPI was also assessed. RESULTS: Twenty-six patients with 352 segments were ultimately included for analysis. The mean radiation dose of CCTACT-MPI generated from dynamic CT-MPI was 3.2 ± 1.1 mSv. Overall, 93.5% of total segments were interpretable (Likert score 2-4) whereas 6.5% segments were non-diagnostic (Likert score 1). Twenty-two patients with 84 segments were diagnosed by CCTACT-MPI as having ≥ 50% stenosis presence, whereas 268 segments had no obstructive stenosis. Compared to ICA findings, the overall diagnostic accuracy of CCTACT-MPI of patient-based and vessel-based as well segment-based analysis was 92.3%, 83.6%, and 85.8% respectively. As shown by ROC analysis, the AUC of CCTACT-MPI for detection of ≥ 50% stenosis was 0.833 on a per-patient level, 0.843 on a per-vessel level, and 0.822 on a per-segment level. CONCLUSIONS: CCTACT-MPI derived from dynamic CT-MPI was able to accurately diagnose obstructive coronary stenosis with reference to ICA. KEY POINTS: • CCTA derived from dynamic CT-MPI had a diagnostic image quality in 93.5% of total segments. • CCTA derived from dynamic CT-MPI was accurate in diagnosing obstructive CAD compared to ICA. • The mean radiation dose of dynamic CT-MPI for reconstruction of CCTA was 3.2 mSv.

Strain Values of Left Ventricular Segments Reduce Non-homogeneously in Dilated Cardiomyopathy with Moderately and Severely Deteriorated Heart Function Assessed by MRI Tissue Tracking Imaging.

Changes of global and segmental ventricular strain at different deterioration levels of cardiac function in patients with dilated cardiomyopathy (DCM) using cardiac magnetic resonance (CMR) have not yet been explored. In total, 101 patients diagnosed with DCM consecutively underwent CMR. They were categorized according to the reduction in left ventricular ejection fraction (LVEF) into the following groups: moderately reduced (n = 43) and severely reduced group (n = 58). LV global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and segmental strain values were assessed using tissue tracking technique. LV segmental circumferential strain (CS) and radial strain (RS) in healthy volunteers increased from base to apex stepwisely. The LV base-to-apex increasing pattern disappeared in the moderate DCM group (RS: 26.61% ± 20.63% versus 21.97% ± 4.85% versus 29.05% ± 9.90%, P > 0.05; CS: -13.16% ± 6.40% versus -12.96%± 2.45% versus -15.32% ± 3.89%, P > 0.05). While in the severe group, CS and RS of base segment had the highest values, there was no significant difference between mid and apex segments. GLSLV, GRSLV, and GCSLV were significantly reduced in moderate and severe groups in steps, similar to the three parameters of RV. During a 17-month median follow-up, 25 patients had an index composite outcome event. GLSLV > -11.62%, GCSLV > -9.35%, and GRSLV≤ 12.42% were significantly associated with the occurrence of cardiac events in DCM patients. LV segmental values reduce non-homogeneously in DCM patients with moderately and severely deteriorated heart function.

Cardiac-Specific Overexpression of Silent Information Regulator 1 Protects Against Heart and Kidney Deterioration in Cardiorenal Syndrome via Inhibition of Endoplasmic Reticulum Stress.

BACKGROUND/AIMS: Increased endoplasmic reticulum (ER) stress contributes to development of cardiorenal syndrome (CRS), and Silent Information Regulator 1 (SIRT1), a class III histone deacetylase, may have protective effects on heart and renal disease, by reducing ER stress. We aimed to determine if SIRT1 alleviates CRS through ER stress reduction. METHODS: Wild type mice (n=37), mice with cardiac-specific SIRT1 knockout (n=29), or overexpression (n=29), and corresponding controls, were randomized into four groups: sham MI (myocardial infarction) +sham STNx (subtotal nephrectomy); MI+sham STNx; sham MI+STNx; and MI+STNx. To establish the CRS model, subtotal nephrectomy (5/6 nephrectomy, SNTx) and myocardial infarction (MI) (induced by ligation of the left anterior descending (LAD) coronary artery) were performed successively to establish CRS model. At week 8, the mice were sacrificed after sequential echocardiographic and hemodynamic studies, and then pathology and Western-blot analysis were performed. RESULTS: Neither MI nor STNx alone significantly influenced the other healthy organ. However, in MI groups, STNx led to more severe cardiac structural and functional deterioration, with increased remodeling, increased BNP levels, and decreased EF, Max +dp/dt, and Max -dp/dt values than in sham MI +STNx groups. Conversely, in STNx groups, MI led to renal structural and functional deterioration, with more severe morphologic changes, augmented desmin and decreased nephrin expression, and increased BUN, SCr and UCAR levels. In MI+STNx groups, SIRT1 knockout led to more severe cardiac structural and functional deterioration, with higher Masson-staining score and BNP levels, and lower EF, FS, Max +dp/dt, and Max -dp/dt values; while SIRT1 overexpression had the opposite attenuating effects. In kidney, SIRT1 knockout resulted in greater structural and functional deterioration, as evidenced by more severe morphologic changes, higher levels of UACR, BUN and SCr, and increased desmin and TGF-ß expression, while SIRT1 overexpression resulted in less severe morphologic changes and increased nephrin expression without significant influence on BUN or SCr levels. The SIRT1 knockout but not overexpression resulted in increased myocardial expression of CHOP and GRP78. Cardiac-specific SIRT1 knockout or overexpression resulted in increased or decreased renal expression of CHOP, Bax, and p53 respectively. CONCLUSIONS: Myocardial SIRT1 activation appears protective to both heart and kidney in CRS models, probably through modulation of ER stress.

All-optical imaging and manipulation of whole-brain neuronal activities in behaving larval zebrafish.

All-optical interrogation of population neuron activity is a promising approach to deciphering the neural circuit mechanisms supporting brain functions. However, this interrogation is currently limited to local brain areas. Here, we incorporate patterned photo-stimulation into light-sheet microscopy, allowing simultaneous targeted optogenetic manipulation and brain-wide monitoring of the neuronal activities of head-restrained behaving larval zebrafish. Using this system, we photo-stimulate arbitrarily selected neurons (regions as small as ~10-20 neurons in 3D) in zebrafish larvae with pan-neuronal expression of a spectrally separated calcium indicator, GCaMP6f, and an activity actuator, ChrimsonR, and observe downstream neural circuit activation and behavior generation. This approach allows us to dissect the causal role of neural circuits in brain functions and behavior generation.

Comparison of myocardial transmural perfusion gradient by magnetic resonance imaging to fractional flow reserve in patients with suspected coronary artery disease.

The goal of this study was to evaluate the diagnostic accuracy of transmural perfusion gradient (TPG) and transmural perfusion gradient reserve (TPGR) with 3.0 T cardiac magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) to detect coronary artery stenosis. Quantitative analysis of myocardial perfusion with CMR to diagnosis coronary artery disease (CAD) has been widely accepted. However, traditional transmural myocardial perfusion analysis with CMR neglects that endocardium is more vulnerable to ischemia than epicardium. TPG and TPGR can take the inhomogenous perfusion impairment into account and be more sensitive and specific for diagnosis of CAD. In this study, 71 patients (57 men, age 60.1 ± 6.4 years) with known or suspected CAD referred for invasive angiography study underwent rest and adenosine-induced stress CMR perfusion imaging scan. FFR was attempted to be measured in all major epicardial coronary arteries. FFR ≤0.75 was regarded to indicate a hemodynamic significant coronary lesion. A TPG ≤0.85 predicted significant CAD with sensitivity and specificity of 74.55% and 83.65%, respectively. Sensitivity and specificity of TPGR ≤0.81 were 90.91% and 89.94%, respectively. Area under the receiver-operating curve to detect FFR ≤0.75 was 0.86 for TPG and 0.95 for TPGR. TPGR yielded significantly better sensitivity and specificity for diagnosis of CAD than traditional myocardial blood flow, myocardial perfusion reserve, and TPG (p < 0.0001). In conclusion, TPG and TPGR analyses with MRI are capable of detecting hemodynamic stenosis of coronary artery and superior to traditional myocardial perfusion analysis. Furthermore, TPGR appears to be superior to TPG in the diagnosis of coronary artery stenosis.