ArticleThe international journal of cardiovascular imaging2026
Feasibility of 12-lead ECG reconstruction at rest and during adenosine stress perfusion inside a 3-Tesla MR scanner.
Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background Electrocardiographic (ECG) devices in magnetic resonance (MR) scanners have a narrow bandwidth and suffer from signal distortion, preventing measurement of QRS/ QT durations, or detection of ST/ T-wave changes during ischaemia. We integrated an external device with novel post-processing software into a 3 Tesla (T) scanner to assess feasibility and accuracy for reconstructing 12-lead ECGs prior to and during adenosine infusion. Methods Reference 12-lead ECGs were first recorded outside the MR-environment. Using three MR-safe electrode patches, in-bore ECGs were then recorded prior to and during adenosine infusion. Post-processing removed artefacts and 12-lead ECGs were reconstructed from the raw signal using a subject-specific matrix. In-bore and reference ECGs were compared using Pearson's correlation coefficient on the PQRST waveform and by manual measurements of QRS and QT durations. Adenosine-induced ischaemic changes were compared with corresponding territories on stress perfusion maps. Results In 26 participants (70.8 ± 13.0 years; 34.6% female), in-bore ECGs were recorded without additional scan time. Reconstruction took < 2 min per participant. In-bore and reference ECGs were strongly correlated (r = 0.81, interquartile range 0.72-0.88), and mean differences in QRS and QT durations were small (-12.5 ms [95% limits of agreement - 42.5, 17.5 ms], and - 5.5 ms [-54.6, 43.6 ms] respectively). Ischaemic ECG changes during adenosine predicted stress myocardial blood flow (MBF) < 1.75 ml/g/min with sensitivity 91.7% (95% confidence interval 66.7, 100.0), specificity 59.3% (39.6, 77.6), positive predictive value (PPV) 33.3% (11.4, 57.7), negative predictive value (NPV) 97.0% (90.0, 100.0) and area under curve 0.74 (0.61, 0.86). Conclusion In this proof-of-concept study, in-bore ECGs correlated closely with reference ECGs. In-bore ECGs during stress perfusion have high specificity and NPV, but low sensitivity and PPV for predicting stress MBF < 1.5 ml/g/min. This may hold value for improving R-peak detection, patient monitoring and stress perfusion map interpretation.
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