Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease

Abstract

BackgroundThe use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD.MethodsConsecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings.ResultsImage-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment.ConclusionIn this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

A quantitative comparison between a navigated Cartesian and a self‐navigated radial protocol from clinical studies for free‐breathing 3D whole‐heart bSSFP coronary MRA

“…As an alternative to RSN that uses 1D projections for motion detection, image‐based self‐navigation offers similar efficiency and predictability while also enabling multi‐dimensional motion correction . That approach provided images of high diagnostic value in recent patient studies, but validation in larger cohorts remains to be performed. Furthermore, approaches where both coronary anatomy and cardiac function can be captured in the same acquisition have been proposed, which might facilitate the transition of CMRA into the clinics as conventional cine‐imaging potentially could be replaced by such scans.…”

“…A sequence similar to Stehning et al but with more sophisticated motion detection and a different 3D radial trajectory has been used in some of the largest patient studies with self‐navigated respiratory motion‐correction to date, reaching a total of ~300 subjects. More recently, image‐based self‐navigation has also been clinically evaluated with promising results …”

“…More recently, image-based self-navigation has also been clinically evaluated with promising results. 23,24 Navigator-gated and respiratory self-navigated wholeheart CMRA have co-existed for many years; therefore, a systematic side-by-side comparison using optimized protocols from large published patient studies is warranted. Our aim is to perform a quantitative comparison of these 2 techniques by replicating protocols from published patient studies as closely as possible and systematically acquiring these protocols in healthy volunteers.…”

Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review

“…Despite advances in diagnosis and management, coronary artery disease (CAD) remains a leading cause of morbidity and mortality. CMR continues to provide unique insights with regards to detection with vasodilator CMR stress testing [27–34], and the role of CMR in myocardial infarction detection [35], area at risk in acute ST elevation myocardial infarction (STEMI) [36–38] and post-infarction remodeling [39–42]. Despite its widespread clinical use for over a decade, improvements in LGE continued [43] in addition to advances in with dark blood [44, 45] and combined LGE and coronary artery imaging [46].…”

Journal of Cardiovascular Magnetic Resonance 2017

“…Coronary artery CMR continues to be limited by motion suppression issues with diaphragmatic navigator the current standard. In this 1.5T study, Hennigsson et al [76] performed coronary artery CMR in 31 consecutive patients using image-based respiratory gating. Diagnostic image quality was found in 98% of proximal coronary arteries and 94% of middle segments with patient based sensitivity and specificity for disease in 86% and 83%, respectively.…”