OBJECTIVESWe sought to determine the diagnostic performance of whole-heart coronary magnetic resonance (MR) angiography for detecting significant coronary artery disease. BACKGROUND The accuracy of whole-heart coronary MR angiography has not been determined in a large number of patients. METHODSThree-dimensional coronary MR angiograms covering the entire heart were obtained during free breathing in 131 patients. Images were acquired during a patient-specific time window in the cardiac cycle with minimal motion of the coronary artery. Significant coronary artery disease was defined on X-ray coronary angiography as a diameter reduction of Ն50% in coronary arteries with a reference diameter of Ն2 mm. RESULTSThe acquisition of MR angiography was completed in 113 (86%) of 131 patients, with an imaging time averaged at 12.9 Ϯ 4.3 min. On a patient-based analysis, the sensitivity, specificity, positive and negative predictive value, and accuracy of MR angiography were 82% (95% confidence interval [CI] 69% to 91%), 90% (95% CI 79% to 96%), 88% (95% CI 74% to 95%), 86% (95% CI 75% to 93%), and 87% (95% CI 79% to 92%), respectively. These values in the individual segments were 78% (95% CI 68% to 85%), 96% (95% CI 95% to 97%), 69% (95% CI 60% to 77%), 98% (95% CI 96% to 98%), and 94% (95% CI 96% to 96%). CONCLUSIONS Whole-heart coronary MR angiography allows for noninvasive detection of significant narrowing in coronary arterial segments with a diameter of Ն2 mm with moderate sensitivity and high specificity. (J Am Coll Cardiol 2006;48:1946 -50) A previous multicenter study demonstrated that 3-dimensional respiratory-gated coronary magnetic resonance (MR) angiography reliably identifies patients with left main coronary artery or 3-vessel disease (1). However, coronary MR angiography remains time-consuming because only a limited portion of the entire coronary arteries is imaged for each double-oblique acquisition. Whole-heart coronary MR angiography using a See page 1951free-breathing, 3-dimensional steady-state free precession sequence recently has been introduced as a method that can provide visualization of all 3 major coronary arteries (2-4).With this method, one can visualize long segments of major coronary vessels with reduced total examination time. However, the accuracy of whole-heart coronary MR angiography for detecting coronary stenoses has not been determined in a large number of patients. Consequently, we conducted a prospective study to investigate the diagnostic value of this method for the detection of obstructive coronary artery disease. METHODS Patients.During a period of 14 months from January 2004, 145 subjects were consecutively recruited from patients with suspected coronary artery disease who were scheduled for elective X-ray coronary angiography. Exclusion criteria included general contraindications to MR examination, unstable angina, atrial fibrillation, and previous coronary artery bypass graft surgery. Fourteen patients were excluded based on these exclusion criteria. Thus, the study population co...

Non-contrast-enhanced whole-heart coronary MRA at 1.5-T can noninvasively detect significant CAD with high sensitivity and moderate specificity. A negative predictive value of 88% indicates that whole-heart coronary MRA can rule out CAD.

This study had institutional review board approval, and all patients gave informed consent. The purpose of this study was to prospectively evaluate the use of whole-heart three-dimensional (3D) coronary magnetic resonance (MR) angiography in patients suspected of having coronary artery disease. Whole-heart coronary MR angiography was performed in 39 patients (30 men and nine women; mean age, 63.9 years +/- 15.6 [standard deviation]) by using a steady-state free precession sequence with free breathing. Twenty patients (16 men and four women; mean age, 64.9 years +/- 11.7) also underwent conventional coronary angiography. MR angiography was successfully completed in 34 of 39 patients (87%); the average imaging time was 13.8 minutes +/- 3.8. Sensitivity and specificity of MR angiography for detecting significant stenosis were 82% (14 of 17 arteries) and 91% (39 of 43 arteries), respectively. Whole-heart coronary MR angiography with a navigator-gated steady-state sequence can enable reliable 3D visualization of the coronary arteries in patients suspected of having coronary artery disease.

Native T1 exhibited comparable ability as ECV measurement in the detection and quantification of histological collagen volume fraction, with high reproducibility, and therefore diffuse myocardial fibrosis in DCM may be reliably assessed by native T1 mapping without the administration of gadolinium contrast agent. In addition, cardiac magnetic resonance-derived ECV showed excellent agreement with histological extracellular space.

The objectives of this study were to develop a method for quantifying myocardial K 1 and blood flow (MBF) with minimal operator interaction by using a Patlak plot method and to compare the MBF obtained by perfusion MRI with that from coronary sinus blood flow in the resting state. A method that can correct for the nonlinearity of the blood time-signal intensity curve on perfusion MR images was developed. Myocardial perfusion MR images were acquired with a saturation-recovery balanced turbo field-echo sequence in 10 patients. Coronary sinus blood flow was determined by phasecontrast cine MRI, and the average MBF was calculated as coronary sinus blood flow divided by left ventricular (LV) mass obtained by cine MRI. Patlak plot analysis was performed using the saturation-corrected blood time-signal intensity curve as an input function and the regional myocardial time-signal intensity curve as an output function. Dynamic MRI following the bolus injection of gadolinium contrast medium permits the assessment of first-pass myocardial enhancement, which can yield information concerning regional myocardial blood flow (MBF). First-pass myocardial perfusion MR images obtained in patients have been evaluated by visual assessment (1-3) and by semiquantitative approaches such as upslope analysis of the myocardial time-intensity curve (4 -7). The use of fullyquantitative analysis of myocardial first-pass contrast-enhanced MRI allows the absolute quantification of MBF in units of ml/min/100 g and may permit more accurate and objective assessment of altered myocardial perfusion in patients with heart disease. Quantitative analysis of firstpass contrast-enhanced MRI has been performed by either a Fermi function deconvolution method (8 -14) or compartment model analysis (15)(16)(17)(18)(19)(20).Quantitative assessment of myocardial perfusion MRI with a compartmental analysis approach has been investigated by several investigators since the early 1990s. Diesbourg et al. (16) used a modified Kety equation to determine the myocardial tissue distribution and clearance of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) from contrast-enhanced MR images (15,16). Larsson et al. (17,18) quantified MBF from contrast-enhanced MR images of the human heart using two-compartment model analysis. The unidirectional influx constant (Ki) of Gd-DTPA across the capillary membrane in human myocardium was quantified by measuring the longitudinal relaxation rate (R 1 ) of the myocardium with contrast-enhanced MRI and obtaining the input function with arterial blood sampling. The Ki value, which is related to the extraction fraction (E) and MBF by the equation Ki ϭ E ⅐ MBF, was 54 Ϯ 10 ml/min/100 g in their study. Vallée et al. (19) modified Larsson et al.'s (17,18) two-compartment model by defining the myocardial capillaries and the extracellular space as a single compartment. A region-ofinterest (ROI) was placed in the left ventricular (LV) chamber to measure the arterial input function from first-pass contrast-enhanced MR images. It should...