Coronary Magnetic Resonance Angiography for the Detection of Coronary Stenoses

Kim, W. Yong; Danias, Peter G.; Stuber, Matthias; Flamm, Scott D.; Plein, Sven; Nagel, Eike; Langerak, Susan E.; Weber, O.; Pedersen, Erik Morre; Schmidt, Matthias; Botnar, René M.; Manning, Warren J.

doi:10.1056/nejmoa010866

Cited by 798 publications

(250 citation statements)

References 33 publications

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“…Since then it has undergone significant progress, such as the development of higher magnet field strength and dedicated cardiac coils as well as advanced data acquisition techniques which included free-breathing navigator gating [4,5,6] and parallel imaging [7,8], leading to improvement in spatial resolution and image quality. In a first multicenter trial, magnetic resonance (MR) imaging of the coronary arteries was shown to permit accurate diagnosis of left main coronary artery and 3-vessel disease [9]. Subsequently, a single-center study demonstrated that whole-heart CMRA using a steady-state free precession (SSFP) sequence provides faster acquisition (<15 min) and superior accuracy with moderate sensitivity and high specificity [10].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Detection of Coronary Artery Stenoses with Contrast-Enhanced Whole-Heart Coronary Magnetic Resonance Angiography at 3.0 T

Chen¹,

Duan²,

Xue³

et al. 2010

Cardiology

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Purpose: To prospectively evaluate the accuracy of contrast-enhanced whole-heart coronary magnetic resonance angiography (CMRA) at 3.0 T, with the use of sublingual nitroglycerin and abdominal banding, for assessing significant stenosis (≧50% lumen diameter reduction) in patients with suspected coronary disease, using conventional coronary artery angiography as the reference standard. Methods: We prospectively studied 71 consecutive patients with suspected coronary artery disease scheduled for conventional coronary angiography. Contrast-enhanced whole-heart CMRA was performed after sublingual nitroglycerin with an abdominal banding rolled tightly along the side of the ribs. The diagnostic performance of CMRA for the detection of significant lesions was compared with that of quantitative coronary angiography. Results: The acquisition of CMRA was completed in 67 of 71 patients, with an average imaging time of 9.6 ± 3.2 min. The average navigator efficiency was 48%. The sensitivity, specificity as well as positive and negative predictive values of whole-heart CMRA for the detection of significant lesions on a segment-by-segment analysis were 91.4, 85.8, 48.7 and 98.5%, respectively, and in a patient-based analysis 94.6, 86.7, 89.7 and 92.9%, respectively. Conclusions: Contrast-enhanced whole-heart CMRA with 3.0 T optimized by using sublingual nitroglycerin and abdominal banding methods permits reliable detection of significant obstructive coronary artery disease in patients with suspected coronary disease.

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Section: Introductionmentioning

confidence: 99%

Noninvasive Detection of Coronary Artery Stenoses with Contrast-Enhanced Whole-Heart Coronary Magnetic Resonance Angiography at 3.0 T

Chen¹,

Duan²,

Xue³

et al. 2010

Cardiology

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“…The use of cardiac magnetic resonance for coronary angiography of the native vessel has been shown to be feasible, especially for the proximal and middle segments of the major coronary arteries. However, it remains technically challenging [4][5][6][7]. Using current three-dimensional approaches in a navigator-based sequence, good results have been obtained.…”

Section: Image Of the Monthmentioning

confidence: 99%

Multiple Coronary Artery Aneurysms Detected by Cardiac Magnetic Resonance Imaging

Bernhardt

Spiess²,

Hombach

2007

Herz

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A 46-year-old male with acute coronary syndrome and signs of anteroseptal myocardial infarction without ST elevation on ECG (NSTEMI) presented for admission to hospital. Troponin I was elevated to 4.15 µg/l. Treatment with isosorbide dinitrate was initiated and led to resolution of symptoms.No wall motion abnormalities, signs of inducible myocardial ischemia by adenosine stress first-pass or myocardial necrosis could be visualized by cardiac magnetic resonance imaging. An additionally performed magnetic resonance coronary angiography showed multiple aneurysms in the proximal and middle segments of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA; see Figure 1). A 1.5-T (Intera, Philips Medical Systems, Best, The Netherlands) magnetic resonance system was therefore used with a navigator-based steady-state free-precession three-dimensional whole-heart SSFP sequence (TR 3.8 ms, TE 1.9 ms, voxel size 0.9 × 0.9 × 2.0 mm, fat suppression, T2prep echo time 50 ms, trigger delay individually optimized dependent on diastolic rest determined with a standard functional protocol). For reconstruction we used the Soapbubble Tool 5.0 for PRIDE4 (Philips Medical Systems). We thus diagnosed embolic myocardial infarction probably due to coronary thrombi.On coronary X-ray angiography these findings could be confirmed ( Figure 2). Furthermore, coronary thrombi or occluded peripheral coronary arteries could be excluded. 3 days after admission troponin I had decreased to 1.42 µg/l. A combined anticoagulation treatment with acetylsalicylic acid (100 mg/day) and phenprocoumon (target INR [International Normalized Ratio] range 2.0-3.0) was initiated. Furthermore, the medical treatment was extended with a β-blocker, an ACE inhibitor, and a statin. A magnetic resonance follow-up study was initiated 3 months after first diagnosis and showed no progression of the aneurysms.The proximal and middle segments of the coronary arteries are the most common sites where coronary aneurysms are found [1]. Atherosclerosis is the most prevalent cause for coronary aneurysms [1, 2], but these could also be due to congenital, mycotic, or systemic inflammatory disease such as Kawasaki syndrome [3]. Figure 1. Cardiac magnetic resonance coronary angiography without contrast agent enhancement showing aneurysms of the LAD (1), LCX (2), and RCA (3), respectively.Figure 2. Coronary X-ray angiography of the left coronary arteries with verification of the aneurysms of LAD (1) and LCX (2).

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“…Allerdings reicht die diagnostische Genauigkeit noch nicht zur Erkennung von Stenosen in den Koronararterien selbst aus [45]. Dies ist durch lange Messzeiten pro Herzzyklus, ungenügende räumliche Auflösung, unzureichende Korrektur der Atembewegung sowie ein ungenügendes Signal-zu-Rausch-Verhältnis bedingt.…”

Section: Koronararterien (Abbildung 6)unclassified

Indikationen f�r kardiovaskul�re Magnetresonanztomographie

Nagel

Kelle²,

Fleck

2005

Med Klin

Self Cite

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Cardiovascular magnetic resonance (CMR) has moved from a tool mainly used for congenital heart disease, large vessels, pericardium and tumors to a flexible, highly accurate and rapid method with a broad range of indications. New applications are especially found in patients with ischemic heart disease, ranging from dobutamine stress and adenosine perfusion to scar imaging, viability testing and-increasingly-visualization of the coronary arteries themselves.

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Coronary Magnetic Resonance Angiography for the Detection of Coronary Stenoses

Cited by 798 publications

References 33 publications

Noninvasive Detection of Coronary Artery Stenoses with Contrast-Enhanced Whole-Heart Coronary Magnetic Resonance Angiography at 3.0 T

Noninvasive Detection of Coronary Artery Stenoses with Contrast-Enhanced Whole-Heart Coronary Magnetic Resonance Angiography at 3.0 T

Multiple Coronary Artery Aneurysms Detected by Cardiac Magnetic Resonance Imaging

Indikationen f�r kardiovaskul�re Magnetresonanztomographie

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