The diagnostic value of non-contrast magnetic resonance coronary angiography in the assessment of coronary artery disease: A systematic review and meta-analysis

Performance of 3-T Nonenhanced Whole-Heart bSSFP Coronary MR Angiography: A Comparison with 3-T Modified Dixon Water-Fat Separation Sequence

Purpose To compare the performance of improved nonenhanced whole-heart balanced steady-state free precession (bSSFP) coronary MR angiography (CMRA) with that of the modified Dixon (mDixon) water-fat separation method at 3-T imaging. Materials and Methods From September 2023 to December 2023, patients with suspected coronary artery disease who underwent bSSFP and mDixon CMRA after coronary CT angiography (CCTA) were consecutively recruited. The two sequences' acquisition success rates, subjective image quality scores, objective image quality measurements, and diagnostic performance for coronary stenosis with CCTA as the reference standard were analyzed. Results Sixty-two participants completed two CMRA sequences. Data from 49 participants (30 male and 19 female participants; mean age, 62 years ± 10 [SD]) were ultimately analyzed. The acquisition success rates, overall subjective image quality scores, apparent signal-to-noise ratios, and contrast-to-noise ratios of bSSFP and mDixon were significantly different: 93.5% versus 80.6% (P = .021), 5 versus 4 (P < .001), 33.4 ± 10.6 versus 20.7 ± 7.5 (P < .001), and 14.9 ± 6.2 versus 7.0 ± 3.1 (P < .001), respectively. The sensitivity and specificity of bSSFP in predicting stenosis greater than or equal to 50% were 94.7% (95% CI: 71.9, 99.7) and 96.7% (95% CI: 80.9, 99.8) per participant, 95.8% (95% CI: 76.9, 99.8) and 96.7% (95% CI: 91.3, 98.9) per vessel, and 96.6% (95% CI: 80.4, 99.8) and 99.0% (95% CI: 97.3, 99.7) per segment, respectively. Conclusion Compared with the mDixon water-fat separation method, the improved nonenhanced whole-heart bSSFP sequence performed excellently at 3-T imaging. Nonenhanced bSSFP CMRA sequences at 3-T imaging may be recommended for broader clinical applications. Keywords: Coronary Arteries, Imaging Sequences, Comparative Studies, Technology Assessment, Cardiac, MR Angiography, Coronary Angiography, MRI, Image Quality Enhancement Supplemental material is available for this article. © RSNA, 2025.

Optimization of the acceleration of compressed sensing in whole-heart contrast-free coronary magnetic resonance angiography

BACKGROUND

This study aims to identify optimal acceleration factors (AFs) for compressed sensing (CS) technology to enhance its clinical application for suspected coronary artery disease (CAD) in whole-heart non-contrast coronary magnetic resonance angiography (CMRA).

METHODS

Two hundred and seventeen individuals with suspected CAD underwent whole-heart non-contrast CMRA on a 1.5T CMR scanner with CS AFs of 2, 4, and 6 (CS2, CS4, and CS6). Two radiologists independently and blindly scored the image quality. The overall image scores, coronary artery segment scores, signal-to-noise ratios (SNR), contrast-to-noise ratios (CNR), and scan times were compared. The scores for the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) were assessed. Of the 217 patients, 37 (37/217, 17.1%) underwent x-ray coronary angiography (CAG). The images from CS2, CS4, and CS6 were evaluated by two radiologists blinded to CAG results to identify significant luminal narrowing. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

RESULTS

The CS2 group exhibited higher overall scores, coronary artery segment scores, SNR, and CNR, but longer scan times compared to the CS4 and CS6 groups (overall score: 24.5 vs 22.0 vs 21.0, p < 0.001; SNR: 127 vs 112 vs 99, p < 0.001; CNRcor-fat: 118 vs 101 vs 84, p < 0.001; CNRcor-myo: 69.7 vs 62.8 vs 53.5, p < 0.001; scan time: 884 ± 308 s vs 473 ± 163 s vs 331 ± 146 s, p < 0.001). Proximal and middle segments received higher scores compared to their corresponding distal segments, and the RCA exhibited higher image quality than LAD and LCX in all groups (p < 0.05). In the subgroup analysis, 19 (19/37, 51.3%) were diagnosed with CAD by CAG. The sensitivity, specificity, PPV, NPV, and accuracy were as follows: CS2 (94.7%, 88.9%, 90.0%, 94.1%, and 91.9%), CS4 (89.5%, 94.4%, 94.4%, 89.5%, and 91.9%), and CS6 (89.5%, 66.7%, 73.9%, 85.7%, and 78.4%), respectively, in patient-based analysis.

CONCLUSION

Image quality showed a decreasing trend with increasing CS AFs, while scan time decreased in non-contrast CMRA. A scanning protocol using CS4 provided high-quality images with relatively short scan times and showed potential for detecting significant coronary stenosis, making it an optimal protocol for coronary magnetic resonance imaging.

Accelerated 3D whole-heart non-contrast-enhanced mDIXON coronary MR angiography using deep learning-constrained compressed sensing reconstruction

OBJECTIVES

To investigate the feasibility of a deep learning-constrained compressed sensing (DL-CS) method in non-contrast-enhanced modified DIXON (mDIXON) coronary magnetic resonance angiography (MRA) and compare its diagnostic accuracy using coronary CT angiography (CCTA) as a reference standard.

METHODS

Ninety-nine participants were prospectively recruited for this study. Thirty healthy subjects (age range: 20-65 years; 50% female) underwent three non-contrast mDIXON-based coronary MRA sequences including DL-CS, CS, and conventional sequences. The three groups were compared based on the scan time, subjective image quality score, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The remaining 69 patients suspected of coronary artery disease (CAD) (age range: 39-83 years; 51% female) underwent the DL-CS coronary MRA and its diagnostic performance was compared with that of CCTA.

RESULTS

The scan time for the DL-CS and CS sequences was notably shorter than that of the conventional sequence (9.6 ± 3.1 min vs 10.0 ± 3.4 min vs 13.0 ± 4.9 min; p < 0.001). The DL-CS sequence obtained the highest image quality score, mean SNR, and CNR compared to CS and conventional methods (all p < 0.001). Compared to CCTA, the accuracy, sensitivity, and specificity of DL-CS mDIXON coronary MRA per patient were 84.1%, 92.0%, and 79.5%; those per vessel were 90.3%, 82.6%, and 92.5%; and those per segment were 98.0%, 85.1%, and 98.0%, respectively.

CONCLUSION

The DL-CS mDIXON coronary MRA provided superior image quality and short scan time for visualizing coronary arteries in healthy individuals and demonstrated high diagnostic value compared to CCTA in CAD patients.

CRITICAL RELEVANCE STATEMENT

DL-CS resulted in improved image quality with an acceptable scan time, and demonstrated excellent diagnostic performance compared to CCTA, which could be an alternative to enhance the workflow of coronary MRA.

KEY POINTS

Current coronary MRA techniques are limited by scan time and the need for noise reduction. DL-CS reduced the scan time in coronary MR angiography. Deep learning achieved the highest image quality among the three methods. Deep learning-based coronary MR angiography demonstrated high performance compared to CT angiography.

Dataset for Automatic Region-based Coronary Artery Disease Diagnostics Using X-Ray Angiography Images

X-ray coronary angiography is the most common tool for the diagnosis and treatment of coronary artery disease. It involves the injection of contrast agents into coronary vessels using a catheter to highlight the coronary vessel structure. Typically, multiple 2D X-ray projections are recorded from different angles to improve visualization. Recent advances in the development of deep-learning-based tools promise significant improvement in diagnosing and treating coronary artery disease. However, the limited public availability of annotated X-ray coronary angiography image datasets presents a challenge for objective assessment and comparison of existing tools and the development of novel methods. To address this challenge, we introduce a novel ARCADE dataset with 2 objectives: coronary vessel classification and stenosis detection. Each objective contains 1500 expert-labeled X-ray coronary angiography images representing: i) coronary artery segments; and ii) the locations of stenotic plaques. These datasets will serve as a benchmark for developing new methods and assessing existing approaches for the automated diagnosis and risk assessment of coronary artery disease.

PET-MRI of Coronary Artery Disease

Simultaneous positron emission tomography and magnetic resonance imaging (PET-MRI) combines the anatomical detail and tissue characterization of MRI with the functional information from PET. Within the coronary arteries, this hybrid technique can be used to identify biological activity combined with anatomically high-risk plaque features to better understand the processes underlying coronary atherosclerosis. Furthermore, the downstream effects of coronary artery disease on the myocardium can be characterized by providing information on myocardial perfusion, viability, and function. This review will describe the current capabilities of PET-MRI in coronary artery disease and discuss the limitations and future directions of this emerging technique. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Feasibility of 3.0 T balanced fast field echo non-contrast-enhanced whole-heart coronary magnetic resonance angiography

Background

Coronary artery disease (CAD) is one of the most common diseases seriously harmful to human health caused by atherosclerosis. Besides coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA), coronary magnetic resonance angiography (CMRA) has become an alternative examination. The purpose of this study was to prospectively evaluate the feasibility of 3.0 T free-breathing whole-heart non-contrast-enhanced coronary magnetic resonance angiography (NCE-CMRA).

Methods

After Institutional Review Board approval, the NCE-CMRA data sets of 29 patients acquired successfully at 3.0 T were evaluated independently by two blinded readers for visualization and image quality of coronary arteries using the subjective quality grade. The acquisition times were recorded in the meantime. A part of the patients had undergone CCTA, we represented stenosis by scores and used the Kappa to evaluate the consistency between CCTA and NCE-CMRA.

Results

Six patients did not get diagnostic image quality because of severe artifacts. The image quality score assessed by both radiologists is 3.2±0.7, which means the NCE-CMRA can show the coronary arteries excellently. The main vessels of the coronary artery on NCE-CMRA images are considered reliably assessable. The acquisition time of NCE-CMRA, is 8.8±1.2 min. The Kappa of CCTA and NCE-CMRA on detecting stenosis is 0.842 (P<0.001).

Conclusions

The NCE-CMRA results in reliable image quality and visualization parameters of coronary arteries within a short scan time. The NCE-CMRA and CCTA have a good agreement for detecting stenosis.

3D whole-heart noncontrast coronary MR angiography based on compressed SENSE technology: a comparative study of conventional SENSE sequence and coronary computed tomography angiography

OBJECTIVE

The relatively long scan time has hampered the clinical use of whole-heart noncontrast coronary magnetic resonance angiography (NCMRA). The compressed sensitivity encoding (SENSE) technique, also known as the CS technique, has been found to improve scan times. This study aimed to identify the optimal CS acceleration factor for NCMRA.

METHODS

Thirty-six participants underwent four NCMRA sequences: three sequences using the CS technique with acceleration factors of 4, 5, and 6, and one sequence using the conventional SENSE technique with the acceleration factor of 2. Coronary computed tomography angiography (CCTA) was considered as a reference sequence. The acquisition times of the four NCMRA sequences were assessed. The correlation and agreement between the visible vessel lengths obtained via CCTA and NCMRA were also assessed. The image quality scores and contrast ratio (CR) of eight coronary artery segments from the four NCMRA sequences were quantitatively evaluated.

RESULTS

The mean acquisition time of the conventional SENSE was 343 s, while that of CS4, CS5, and CS6 was 269, 215, and 190 s, respectively. The visible vessel length from the CS4 sequence showed good correlation and agreement with CCTA. The image quality score and CR from the CS4 sequence were not statistically significantly different from those in the other groups (p > 0.05). Moreover, the image score and CR showed a decreasing trend with the increase in the CS factor.

CONCLUSIONS

The CS technique could significantly shorten the acquisition time of NCMRA. The CS sequence with an acceleration factor of 4 was generally acceptable for NCMRA in clinical settings to balance the image quality and acquisition time.

Assessment of Non-contrast-enhanced Dixon Water-fat Separation Compressed Sensing Whole-heart Coronary MR Angiography at 3.0 T: A Single-center Experience

RATIONALE AND OBJECTIVES

The clinical utility of Dixon water-fat separation coronary MR angiography (CMRA) with compressed sensing (CS) reconstruction has not been determined in a patient population. This study was designed to evaluate the performance of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA sequence in vitro and in vivo.

MATERIALS AND METHODS

In vitro phantom MRI, we compared key parameters of the SENSE and CS images. And in this prospective in vivo study, from November 2019 to October 2020, 94 participants were recruited for 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using X-ray coronary angiography (CA) as the reference method.

RESULTS

Compared with SENSE, CS with an appropriate acceleration factor offers both higher SNR/CNR (p < 0.05) and a shortened acquisition. Fifty-eight patients successfully completed the CMRA and CA. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA according to a patient-based analysis were 96.4%, 66.7%, 73.0%, 95.2% and 81.0%, respectively. The area under the receiver-operator characteristic (ROC) curve (AUC) of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA for detecting significant coronary artery stenosis is 0.908, 0.895, and 0.904 in patient-, vessel-, and segment-based analyses respectively.

CONCLUSION

3.0 T non-contrast-enhanced Dixon water-fat separation whole-heart CMRA using appropriate CS is a promising noninvasive and radiation-free technique to detect clinically significant coronary stenosis on patients with suspected CAD.

Clinical Application of Non-Contrast-Enhanced Dixon Water-Fat Separation Compressed SENSE Whole-Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin

BACKGROUND

3.0 T non-contrast-enhanced nitroglycerin (NTG)-assisted whole-heart coronary magnetic resonance angiography (MRA) employing Dixon water-fat separation and compressed SENSE (CS-SENSE) acceleration is a promising method for diagnosing coronary artery disease (CAD).

PURPOSE

To evaluate the diagnostic performance of this technique for detecting clinically-relevant (≥50% diameter reducing) CAD and to evaluate the difference in NTG-induced coronary vasodilation between patients with and without clinically-relevant CAD.

STUDY TYPE

Prospective.

POPULATION

Sixty-six patients with suspected CAD.

FIELD STRENGTH/SEQUENCE

3.0 T; CSSENSE, Dixon water-fat separation, three-dimensional segmented turbo field gradient-echo sequence for whole-heart coronary MRA.

ASSESSMENT

Overall image quality of coronary MRA was calculated on the basis of all visible coronary segments. The diagnostic performance of coronary MRA for detecting a ≥50% reduction in coronary artery diameter with and without NTG was compared using X-ray coronary angiography (CAG) as the reference. According to CAG, patients were divided into a non-clinically-relevant CAD group and clinically-relevant CAD group, and the difference in NTG-induced vasodilation between the groups was evaluated.

STATISTICAL TESTS

Unpaired/paired Student's t-test, Mann-Whitney U test, paired Wilcoxon signed-rank test, χ² test, McNemar test. A two-tailed P value <0.05 was considered significant.

RESULTS

Overall image quality was increased significantly in the coronary MRA images after NTG. The diagnostic performance of the non-NTG vs. NTG-assisted coronary MRA was as follows on a per-patient basis: sensitivity 94.3% vs. 94.3%, specificity 64.5% vs. 83.9%, positive predictive value 75.0% vs. 86.8%, negative predictive value 90.9% vs. 92.9%, and accuracy 80.3% vs. 89.4%, respectively. NTG-induced vasodilation was significantly lower in the clinically-relevant CAD group than in the non-clinically-relevant CAD group (13.7 ± 8.1% vs. 24.1 ± 16.3%).

DATA CONCLUSION

Non-contrast Dixon water-fat separation CS-SENSE coronary MRA at 3.0 T can noninvasively detect clinically-relevant CAD and sublingual NTG improved performance. Combining pre- and post-NTG coronary MRA may provide a simple noninvasive and nonionizing test to evaluate coronary vasodilation function.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 2.