Utility of Free-Breathing, Whole-Heart, Three-Dimensional Magnetic Resonance Imaging in the Assessment of Coronary Anatomy for Congenital Heart Disease

Abstract

The incidence of coronary anomalies is increased in congenital heart disease (CHD). Whole-heart magnetic resonance imaging (MRI) has been proposed as a robust approach to coronary artery imaging without ionizing radiation. The proximal coronary arteries were imaged in 112 CHD patients (63 males) age 17 ± 13 years (range 11 days-68 years) using a navigator-gated, whole-heart, three-dimensional (3D) technique at 1.5 T. Two observers assessed image quality overall and for left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) using a 5-point scale ranging from 0 (not visible) to 4 (clear margins). Weighted kappa was used to assess interobserver agreement. Coronary artery origins were visible in 99% of the patients. The left main origin was not visualized in one patient, although the LAD, LCX, and RCA were visualized. Eight patients (7%) had anomalies. The overall image quality was 3.3 ± 0.8 for reader 1 and 3.1 ± 1.0 for reader 2. Age had a significant effect on image quality, with younger patients having lower scores. Agreement between readers was moderate (overall kappa, 0.60). Free-breathing, navigator-gated, whole-heart 3D MRI is a useful, robust, and reliable noninvasive technique for assessing coronary artery origins and their proximal course with diagnostic quality in CHD patients.

Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population

“…Several studies have shown reliable visualization of proximal coronary artery segments in pediatric patients, but scan quality has been shown to be inversely related to the age and heart rate of the patient, and the MRI coronary scans did not allow definition of stenosis or distal coronary artery segments. [22][23][24] In our experience, we have also had difficulty visualizing distal coronary artery segments, particularly in small children and in postoperative patients with metallic clips, stents, and devices. MRI has no ionizing radiation exposure but a longer scan time and lower spatial resolution.…”

Trends in pediatric cardiovascular magnetic resonance imaging

“…These data can be used during the scan to plan image planes for further scanning, as well as during the . . reporting phase to assess 3D relationships between structures, quantify vessel size, and view morphology (23)(24)(25)(26). † Velocity encoded phase contrast imaging (PC-CMR) is an accurate, robust, and safe technique for obtaining in-vivo blood flow information in major vessels.…”

Cardiac Magnetic Resonance Imaging for the Investigation of Cardiovascular Disorders. Part 2: Emerging Applications

“…4). 40,41 Coronary MR imaging is superior to invasive coronary angiography for delineating the course of anomalous vessels. [42][43][44] Anecdotal reports suggest that coronary MR can be used as part of a multisequence MR protocol to evaluate the functional and clinical signif icance of coronary artery anomalies.…”