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Sareen N, Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. J Nucl Cardiol 2016; 23:1411-1429. [PMID: 26487011 DOI: 10.1007/s12350-015-0152-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022]
Abstract
Medically managed significant left main (LM) stem disease has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up. Despite the clinical significance of LM disease, studies comparing the various diagnostic modalities, especially noninvasive, are sparse. Clinicians, particularly imagers, should be aware of the strengths and weaknesses of existing modalities to diagnose LM disease as integrating many clues (history, symptoms, electrocardiogram, and stress hemodynamics are essential to suspect this diagnosis and proceed to the next step). Here we review the existing data on the current role of electrocardiography, nuclear myocardial perfusion imaging (single photon emission computed tomography and positron emission tomography), stress echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging in diagnostic evaluation of LM disease. Wherever applicable we have extended our discussion to multivessel coronary artery disease encompassing scenarios where LMS can present as LM equivalent with or without extensive multivessel coronary artery disease.
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Affiliation(s)
- Nishtha Sareen
- Department of Cardiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
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Di Leo G, Fisci E, Secchi F, Alì M, Ambrogi F, Sconfienza LM, Sardanelli F. Diagnostic accuracy of magnetic resonance angiography for detection of coronary artery disease: a systematic review and meta-analysis. Eur Radiol 2015; 26:3706-18. [DOI: 10.1007/s00330-015-4134-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 01/20/2023]
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The gold standard for noninvasive imaging in coronary heart disease: magnetic resonance imaging. Curr Opin Cardiol 2009; 24:567-79. [DOI: 10.1097/hco.0b013e3283315553] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Coronary MR imaging is a promising noninvasive technique for the combined assessment of coronary artery anatomy and function. Anomalous coronary arteries and aneurysms can reliably be assessed in clinical practice using coronary MR imaging and the presence of significant left main or proximal multivessel coronary artery disease detected. Technical challenges that need to be addressed are further improvements in motion suppression and abbreviated scanning times aimed at improving spatial resolution and patient comfort. The development of new and specific contrast agents, high-field MR imaging with improved spatial resolution, and continued progress in MR imaging methods development will undoubtedly lead to further progress toward the noninvasive and comprehensive assessment of coronary atherosclerotic disease.
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Affiliation(s)
- Sebastian Kelle
- Division of Cardiology, Department of Medicine, German Heart Institute, Berlin, Germany; Division of Magnetic Resonance Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, Hundley WG, Manning WJ, Printz BF, Stuber M, Woodard PK. Noninvasive coronary artery imaging: magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the american heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation 2008; 118:586-606. [PMID: 18586979 DOI: 10.1161/circulationaha.108.189695] [Citation(s) in RCA: 351] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Affiliation(s)
- Thomas H Hauser
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Manning WJ, Nezafat R, Appelbaum E, Danias PG, Hauser TH, Yeon SB. Coronary Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2007; 15:609-37, vii. [DOI: 10.1016/j.mric.2007.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim YJ, Seo JS, Choi BW, Choe KO, Jang Y, Ko YG. Feasibility and diagnostic accuracy of whole heart coronary MR angiography using free-breathing 3D balanced turbo-field-echo with SENSE and the half-fourier acquisition technique. Korean J Radiol 2007; 7:235-42. [PMID: 17143026 PMCID: PMC2667609 DOI: 10.3348/kjr.2006.7.4.235] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE We wanted to assess the feasibility and diagnostic accuracy of whole heart coronary magnetic resonance angiography (MRA) with using 3D balanced turbo-field-echo (b-TFE) with SENSE and the half-Fourier acquisition technique for identifying stenoses of the coronary artery. MATERIALS AND METHODS Twenty-one patients who underwent both whole heart coronary MRA examinations and conventional catheter coronary angiography examinations were enrolled in the study. The whole heart coronary MRA images were acquired using a navigator gated 3D b-TFE sequence with SENSE and the half-Fourier acquisition technique to reduce the acquisition time. The imaging slab covered the whole heart (80 contiguous slices with a reconstructed slice thickness of 1.5 mm) along the transverse axis. The quality of the images was evaluated by using a 5-point scale (0 - uninterpretable, 1 - poor, 2 - fair, 3 - good, 4 - excellent). Ten coronary segments of the heart were evaluated in each case; the left main coronary artery (LM), and the proximal, middle and distal segments of the left anterior descending (LAD), the left circumflex (LCX) and the right coronary artery (RCA). The diagnostic accuracy of whole heart coronary MRA for detecting significant coronary artery stenosis was determined on the segment-by-segment basis, and it was compared with the results obtained by conventional catheter angiography, which is the gold standard. RESULTS The mean image quality was 3.7 in the LM, 3.2 in the LAD, 2.5 in the LCX, and 3.3 in the RCA, respectively (the overall image quality was 3.0 +/- 0.1). 168 (84%) of the 201 segments had an acceptable image quality (> or =grade 2). The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of the whole heart coronary MRA images for detecting significant stenosis were 81.3%, 92.1%, 91.1%, 97.9%, and 52.0%, respectively. The mean coronary MRA acquisition time was 9 min 22 sec (+/-125 sec). CONCLUSION Whole heart coronary MRA is a feasible technique, and it has good potential to evaluate the major portions of the coronary arteries with an acceptable image quality within a reasonable scan time.
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Affiliation(s)
- Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Jae-Seung Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Byoung Wook Choi
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Kyu Ok Choe
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Yangsoo Jang
- Cardiovascular Division of Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Young-Guk Ko
- Cardiovascular Division of Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea
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Abstract
This article highlights the technical challenges and general imaging strategies for coronary MRI. This is followed by a review of the clinical results for the assessment of anomalous CAD, coronary artery aneurysms, native vessel integrity, and coronary artery bypass graft disease using the more commonly applied MRI methods. It concludes with a brief discussion of the advantages/disadvantages and clinical results comparing coronary MRI with multidetector CT (MDCT) coronary angiography.
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Affiliation(s)
- Warren J Manning
- Departments of Medicine and Radiology, Cardiovascular Division, Harvard-Thorndike Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Cheng L, Gao Y, Guaricci AI, Mulukutla S, Sun W, Sheng F, Foo TK, Prince MR, Wang Y. Breath-hold 3D steady-state free precession coronary MRA compared with conventional X-ray coronary angiography. J Magn Reson Imaging 2006; 23:669-73. [PMID: 16568438 DOI: 10.1002/jmri.20567] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the use of breath-hold three-dimensional (3D) steady-state free precession (SSFP) coronary magnetic resonance angiography (MRA) in patients with coronary artery disease (CAD) in comparison with conventional coronary x-ray angiography (XRA). MATERIALS AND METHODS Twenty-eight patients with suspected CAD were examined with the use of a breath-hold 3D-SSFP-MRA sequence and conventional XRA. To assess the accuracy of MRA, two clinicians who were blinded to patient information independently reviewed the MRA and XRA data, which were presented in a randomized order. To identify discrepancies between MRA and XRA, and assess features of coronary lesions on MRA, two additional clinicians examined MRA and XRA data that were presented side by side, divided into proximal, mid, and distal segments, and compared them segment by segment. RESULTS The sensitivity and specificity for diagnosing significant coronary stenoses (> 50% diameter narrowing) were 64% and 94%, respectively. At sites of coronary lesions identified on XRA, bright signals and enlarged vessel profiles, in addition to the characteristic narrow lumen, were frequently observed on MRA. CONCLUSION Breath-hold SSFP coronary MRA has good specificity but inconclusive sensitivity in diagnosing significant coronary stenoses, and provides important image features for depicting coronary lesions.
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Affiliation(s)
- Liuquan Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Abstract
Over the past decade, coronary magnetic resonance imaging has been transformed from a scientific curiosity to a clinically useful imaging tool for patients with known or suspected anomalous coronary arteries or coronary artery aneurysms and for assessment of coronary artery bypass graft patency. Coronary magnetic resonance imaging also appears to be of clinical value for assessment of native vessel integrity in selected patients, especially those patients with suspected left main/multivessel disease. Among patients referred for X-ray angiography, a normal coronary magnetic resonance imaging strongly suggests the absence of severe multivessel disease. Technical and methodological advances in motion suppression, along with increasing clinical experience will no doubt facilitate improved visualization of the distal and branch vessel.
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Affiliation(s)
- Evan Appelbaum
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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Schuijf JD, Bax JJ, Shaw LJ, de Roos A, Lamb HJ, van der Wall EE, Wijns W. Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography. Am Heart J 2006; 151:404-11. [PMID: 16442907 DOI: 10.1016/j.ahj.2005.03.022] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) have emerged as potential noninvasive coronary imaging techniques. The objective of the present study was to clarify the current accuracy of both modalities in the detection of significant coronary artery lesions (compared to conventional angiography as the gold standard) by means of a comprehensive meta-analysis of the presently available literature. METHODS A total of 51 studies on the detection of significant coronary artery stenoses (> or = 50% diameter stenosis) and comparing results with conventional angiography were identified by means of a MEDLINE search. Weighted sensitivities, specificities, and predictive values, all with 95% CIs, as well as summary odds ratios, were calculated for both techniques. In addition, the relationship between diagnostic specificity and disease prevalence was determined using metaregression analysis. RESULTS A comparison of sensitivities and specificities revealed significantly higher values for MSCT (weighted average 85% [95% CI 86%-88%] and 95% [95% CI 95%]) as compared with MRI (weighted average 72%, 95% CI 69%-75% and 87%, 95% CI 86%-88%). A significantly higher odds ratio (16.9-fold) for the presence of significant stenosis was observed for MSCT as compared with MRI (6.4-fold) (P < .0001). Linear regression analysis revealed a better specificity for MSCT versus MRI in lower disease prevalence populations (P = .056). CONCLUSION Meta-analysis of the available studies with MRI and MSCT for noninvasive coronary angiography indicates that MSCT has currently a significantly higher accuracy to detect or exclude significant coronary artery disease.
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Affiliation(s)
- Joanne D Schuijf
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Danias PG, Roussakis A, Ioannidis JPA. Diagnostic performance of coronary magnetic resonance angiography as compared against conventional X-ray angiography: a meta-analysis. J Am Coll Cardiol 2005; 44:1867-76. [PMID: 15519021 DOI: 10.1016/j.jacc.2004.07.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2003] [Revised: 07/26/2004] [Accepted: 07/29/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study was designed to define the current role of coronary magnetic resonance angiography (CMRA) for the diagnosis of coronary artery disease (CAD). BACKGROUND Coronary magnetic resonance angiography has been proposed as a promising noninvasive method for diagnosis of CAD, but individual studies evaluating its clinical value have been of limited sample size. METHODS We identified all studies (MEDLINE and EMBASE) that evaluated CAD by both CMRA and conventional angiography in >/=10 subjects during the period 1991 to January 2004. We recorded true and false positive and true and false negative CMRA assessments for detection of CAD using X-ray angiography as the reference standard. Analysis was done at segment, vessel, and subject level. RESULTS We analyzed 39 studies (41 separate comparisons). Across 25 studies (27 comparisons) with data on 4,620 segments (993 subjects), sensitivity and specificity for detection of CAD were 73% and 86%, respectively. Vessel-level analyses (16 studies, 2,041 vessels) showed sensitivity 75% and specificity 85%. Subject-level analyses (13 studies, 607 subjects) showed sensitivity 88% and specificity 56%. At the segment level, sensitivity was 69% to 79% for all but the left circumflex (61%) coronary artery; specificity was 82% to 91%. There was considerable between-study heterogeneity, but weighted summary receiver-operating characteristic curves agreed with these estimates. There were no major differences between subgroups based on technical or population characteristics, year of publication, reported blinding, or sample size. CONCLUSIONS In evaluable segments of the native coronary arteries, CMRA has moderately high sensitivity for detecting significant proximal stenoses and may have value for exclusion of significant multivessel CAD in selected subjects considered for diagnostic catheterization.
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Schuijf JD, Kaandorp TAM, Jukema JW, Lamb HJ, de Roos A, van der Wall EE, Bax JJ. Noninvasive evaluation of coronary artery disease: magnetic resonance imaging & multi-slice computed tomography. Future Cardiol 2005; 1:79-86. [DOI: 10.1517/14796678.1.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronary artery disease is the leading cause of death in industrialized countries. Moreover, the disease is reaching endemic proportions and will put an enormous strain on healthcare economics in the near future. Accurate noninvasive diagnosis and functional evaluation of coronary artery disease in early stages is important for selecting the appropriate management strategy in patients with known or suspected coronary artery disease. During the past decade, magnetic resonance imaging and multi-slice computed tomography have emerged as modalities that allow both functional and anatomical imaging of coronary artery disease. Implementation of these modalities may improve the clinical diagnostic workup, prognostification and clinical management of patients with known or suspected coronary artery disease.
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Affiliation(s)
- Joanne D Schuijf
- Leiden University Medical Center, Dept Cardiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.: Fax:
| | - Theodorus AM Kaandorp
- Leiden University Medical Center, Dept Radiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.:
| | - J Wouter Jukema
- Leiden University Medical Center, Dept Cardiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.: Fax:
| | - Hildo J Lamb
- Leiden University Medical Center, Dept Radiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.:
| | - Albert de Roos
- Leiden University Medical Center, Dept Radiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.:
| | - Ernst E van der Wall
- Leiden University Medical Center, Dept Cardiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.: Fax:
| | - Jeroen J Bax
- Leiden University Medical Center, Dept Cardiology, Albinusdreef 2, 2333 ZA Leiden, The Netherlands Tel.: Fax:
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Dhawan S, Dharmashankar KC, Tak T. Role of magnetic resonance imaging in visualizing coronary arteries. Clin Med Res 2004; 2:173-9. [PMID: 15931354 PMCID: PMC1069090 DOI: 10.3121/cmr.2.3.173] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Accepted: 06/22/2004] [Indexed: 11/18/2022]
Abstract
Ischemic heart disease is the leading cause of death worldwide. At present, coronary angiography is the gold standard for the diagnosis of coronary artery disease. Conventional coronary angiography is an invasive procedure with a small, yet inherent risk of myocardial infarction, stroke, potential arrhythmias, and death. Other noninvasive diagnostic tools, such as electrocardiography, echocardiography, and nuclear imaging are now widely available but are limited by their inability to directly visualize and quantify coronary artery stenoses and predict the stability of plaques. Coronary magnetic resonance angiography (MRA) is a technique that allows visualization of the coronary arteries by noninvasive means; however, it has not yet reached a stage where it can be used in routine clinical practice. Although coronary MRA is a potentially useful diagnostic tool, it has limitations. Further research should focus on improving the diagnostic resolution and accuracy of coronary MRA. This review summarizes results from several studies comparing coronary MRA with conventional coronary angiography. Current two-dimensional and three-dimensional coronary MRA techniques and their limitations are also discussed.
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Affiliation(s)
- Sumeesh Dhawan
- Department of Internal Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA
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Vignaux O. [Cardiac magnetic resonance imaging (MRI)]. Presse Med 2004; 33:891-5. [PMID: 15387389 DOI: 10.1016/s0755-4982(04)98779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
TECHNOLOGICAL PROGRESS: Although cardiac magnetic resonance imaging (MRI) is now recognised as the imaging method of choice for the morphological study of the heart, recent technological progress have widened its indications to functional analysis of the heart rate, perfusion and contractility. FUNCTIONAL ASSESSMENT: The possibility of conducting pharmacological stress tests enhances the functional exploration of cardiac perfusion and contractility. The rapid sequences in apnea, tissue marking and injection of contrast products are all elements that help to refine the study of the locoregional consequences of an ischemia: does the myocardial tissue contract normally? Is it sufficiently perfused? Is it still viable? THE BENEFITS OF A NON-INVASIVE TECHNIQUE: The MRI offers clinicians a non-invasive and non-radiating imaging technique that is the perfect supplement to echocardiography. A reliable angio-coronary LRI technique would, for the first time, permit exploration of the coronary vascularisation, tissue perfusion and resulting contractility.
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Affiliation(s)
- Olivier Vignaux
- Service de radiologie A, Hôpital Cochin 27, rue du Fbg St Jacques, 75014 Paris.
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Abstract
Coronary magnetic resonance angiography (coronary MRA) continues to advance rapidly from both a technical and clinical perspective. Coronary MRA has benefited directly from improvements in spatial resolution, contrast definition, and advances in motion correction, which have furthered its routine use in evaluating coronary artery bypass grafts and anomalous coronary arteries. Work in refining the techniques for more accurate identification of coronary artery disease (CAD) continues, with advances in navigator-gated and breath-hold motion correction techniques, novel k-space strategies (e.g., spiral and radial k-space filling), development and application of intravascular contrast agents, and imaging at higher field strengths. Ultimately, these developments may lead to the routine application of coronary MRA as a screening tool for CAD. This article reviews the development of coronary MRA, discusses the requirements and tools necessary for optimal visualization of the coronary arteries, and describes the application of coronary MRA to acquired and congenital CAD.
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Affiliation(s)
- Scott D Flamm
- Department of Radiology, St. Luke's Episcopal Hospital and Texas Heart Institute, Houston, Texas 77030, USA.
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Affiliation(s)
- Rita F Redberg
- Women's Cardiovascular Services, UCSF National Center for Excellence and School of Medicine, Division of Cardiology, University of California, San Francisco, 94143-0124, USA.
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Hutter A, Kedan I, Srokowski TP, Zheng J, Gropler RJ, Woodard PK. Coronary magnetic resonance angiography. Semin Roentgenol 2003; 38:330-41. [PMID: 14621375 DOI: 10.1016/s0037-198x(03)00053-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Alf Hutter
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Department of Medicine, St. Louis, MO, USA
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Nguyen TD, Nuval A, Mulukutla S, Wang Y. Direct monitoring of coronary artery motion with cardiac fat navigator echoes. Magn Reson Med 2003; 50:235-41. [PMID: 12876698 DOI: 10.1002/mrm.10550] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Navigator echoes (NAVs) provide an effective means of monitoring physiological motion in magnetic resonance imaging (MRI). Motion artifacts can be suppressed by adjusting the data acquisition accordingly. The standard pencil-beam NAV has been used to detect diaphragm motion; however, it does not monitor cardiac motion effectively. Here we report a navigator approach that directly measures coronary artery motion by exciting the surrounding epicardial fat and sampling the signal with a k-space trajectory sensitized to various motion parameters. The present preliminary human study demonstrates that superior-inferior (SI) respiratory motion of the coronary arteries detected by the cardiac fat NAV highly correlates with SI diaphragmatic motion detected by the pencil-beam NAV. In addition, the cardiac fat navigator gating is slightly more effective than the diaphragmatic navigator gating in suppressing motion artifacts in free-breathing 3D coronary MR angiography (MRA).
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Affiliation(s)
- Thanh D Nguyen
- MR Research Center, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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Mao S, Lu B, Takasu J, Oudiz RJ, Budoff MJ. Measurement of the RT interval on ECG records during electron-beam CT. Acad Radiol 2003; 10:638-43. [PMID: 12809417 DOI: 10.1016/s1076-6332(03)80082-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The R wave of the electrocardiogram is used widely as a trigger for cardiac imaging. This study was designed to determine the optimal interval between the R wave and end systole for triggering of electron-beam computed tomography (CT) in a group of patients with various heart rates who are undergoing assessment for coronary artery calcification. MATERIALS AND METHODS A total of 862 consecutive asymptomatic patients referred for screening with electron-beam CT for coronary artery calcification were enrolled in the study. Patients' R-R, RT, and PR intervals were measured by using the software of the CT console computer. Correlation coefficients were computed and linear regression analyses were performed for all intervals measured. Results were analyzed according to patient age (three subgroups), sex (two subgroups), and heart rate (nine subgroups). Separate formulas for calculating the length of RT intervals in men and in women were developed. RESULTS After correction for heart rate, a significant difference was found in mean RT and PR intervals between women and men, with the mean intervals in women being longer (P < .001). No significant difference was found in these intervals within the three age-defined subgroups (< or = 40, 41-60, and >60 years; P > .05). However, significant negative correlations were found between heart rates and the lengths of all measured intervals. The results of statistical analysis indicate that most of the variation in the R-R interval with different heart rates occurred in diastole and that the duration of systole was relatively constant. CONCLUSION For optimal cardiac imaging, triggering should take place in late systole, avoiding the RT interval variability that occurs in diastole.
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Affiliation(s)
- Songshou Mao
- Saint John's Cardiovascular Research Center, Research and Education Institute, Harbor-UCLA Medical Center, 1124 W Carson St, RB2, Torrance, CA 90502, USA
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Dirksen MS, Lamb HJ, Kunz P, Robert P, Corot C, de Roos A. Improved MR coronary angiography with use of a new rapid clearance blood pool contrast agent in pigs. Radiology 2003; 227:802-8. [PMID: 12676975 DOI: 10.1148/radiol.2273020671] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate in an animal model the potential for clinical use of a new rapid clearance blood pool contrast agent to improve free-breathing and breath-hold magnetic resonance (MR) coronary angiography. MATERIALS AND METHODS Free-breathing and breath-hold MR coronary angiography were performed in a pig model (n = 9) (a) without use of a contrast agent; (b) with P792 (Guerbet Research, Aulnay Sous Bois, France), a monodisperse monogadolinated macromolecular compound that acts as a blood pool contrast agent with rapid clearance properties; and (c) with an extravascular gadolinium-based contrast agent. This resulted in six imaging options, which were compared in terms of contrast-to-noise ratio (CNR), signal-to-noise ratio, and vessel length measurements by using the Student t test. RESULTS Use of P792 improved CNR and visible vessel length significantly with both MR respiratory motion correction approaches, as compared with nonenhanced MR imaging (P <.05). CNR was improved by 76% (from 5.0 to 8.6) with the free-breathing approach and by 34% (from 6.2 to 8.2) with the breath-hold approach. Visible vessel length was increased by 27% (from 79.7 to 99.2 mm) with the free-breathing approach and by 90% (from 48.2 to 86.5 mm) with the breath-hold approach. The P792-enhanced free-breathing approach allowed more distal visualization of the coronary arteries than did the P792-enhanced breath-hold approach (P <.05). Use of the extravascular contrast agent did not improve image quality significantly when compared with that of nonenhanced MR images. CONCLUSION Use of P792 improves coronary artery MR imaging in conjunction with free-breathing and breath-hold approaches.
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Affiliation(s)
- Martijn S Dirksen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Rm 62, Post Zone C2-S, 2333 ZA Leiden, The Netherlands.
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Regenfus M, Ropers D, Achenbach S, Schlundt C, Kessler W, Laub G, Moshage W, Daniel WG. Diagnostic value of maximum intensity projections versus source images for assessment of contrast-enhanced three-dimensional breath-hold magnetic resonance coronary angiography. Invest Radiol 2003; 38:200-6. [PMID: 12649643 DOI: 10.1097/01.rli.0000057030.71459.7f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES We compared maximum intensity projections (MIP) versus original source images (SI) in respect to detection of coronary artery stenoses by means of magnetic resonance (MR) coronary angiography. METHODS MR coronary angiography was performed on 61 patients. MIP and SI were independently evaluated as to presence of significant stenoses in the proximal and midcoronary segments and compared with x-ray angiography. RESULTS A total of 315 of 427 (74%) coronary artery segments could be evaluated in MIP and 328 of 427 (77%) in SI. In segments able to be evaluated, MIP images demonstrated 84% (54/64) sensitivity and 87% (219/251) specificity, whereas SI images showed 85% (58/68) sensitivity and 90% (235/260) specificity. Overall accuracy was 87% (273/310) for MIP and 89% (293/328) for SI. There was no statistically significant difference between both modalities. CONCLUSIONS The MIP reconstructions showed comparable accuracy to unprocessed SI. However, MIP postprocessing is compromised by a higher number of images that were unable to be evaluated due to overlap of coronary arteries with adjacent cardiac structures.
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Affiliation(s)
- Matthias Regenfus
- Department of Internal Medicine II, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Ulmenweg 18, 91054 Erlangen, Germany.
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Bogaert J, Kuzo R, Dymarkowski S, Beckers R, Piessens J, Rademakers FE. Coronary artery imaging with real-time navigator three-dimensional turbo-field-echo MR coronary angiography: initial experience. Radiology 2003; 226:707-16. [PMID: 12601209 DOI: 10.1148/radiol.2263011750] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine the value of a commercially available three-dimensional (3D) real-time navigator magnetic resonance (MR) coronary angiographic examination for detection of significant coronary artery stenoses, with conventional coronary angiography as the standard of reference. MATERIALS AND METHODS Twenty-one patients underwent 3D navigator MR coronary angiography immediately before catheterization. Two observers independently graded image quality on a scale from 1 (unreadable) to 5 (excellent), quantified coronary artery visualization, and evaluated the presence of significant (ie, >50% narrowing) stenoses. kappa statistics were used to assess interobserver agreement, and receiver operating characteristic (ROC) analysis was used to assess stenosis detection. RESULTS For two of 21 patients, MR coronary angiogram quality was insufficient for analysis (mean score < 2). For the remaining 19 patients, the mean image quality scores assigned by observers 1 and 2 were 3.3 +/- 1.0 (SD) and 3.2 +/- 0.9, respectively. A mean of 71% of all coronary artery segments were visible at MR coronary angiography, and there was 91% agreement between the observers (kappa = 0.78). Observers 1 and 2 detected significant stenoses (n = 29) at MR coronary angiography with sensitivities of 44.4% and 55.5%, respectively; specificities of 95.1% and 83.7%, respectively; and 80% agreement (kappa = 0.35). Areas under the ROC curve were 0.817 and 0.795 for observers 1 and 2, respectively. CONCLUSION Large portions of the coronary arteries can be visualized with MR coronary angiography. Imaging results are not consistently reliable, however. The examination is premature for routine clinical assessment of significant coronary artery stenosis owing to low sensitivity and large observer variability.
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Affiliation(s)
- Jan Bogaert
- Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium.
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26
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Danias PG, Stuber M, Botnar RM, Kissinger KV, Yeon SB, Rofsky NM, Manning WJ. Coronary MR angiography clinical applications and potential for imaging coronary artery disease. Magn Reson Imaging Clin N Am 2003; 11:81-99. [PMID: 12797512 DOI: 10.1016/s1064-9689(02)00022-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Over the past decade, CMRA has emerged as a unique clinical imaging tool with applications in selected populations. Patients with suspected coronary artery anomalies and patients with Kawasaki disease and coronary aneurysms are among those for whom CMRA has demonstrated clinical usefulness. For assessment of patients with atherosclerotic CAD, CMRA is useful for detection of patency of bypass grafts. At centers with appropriate expertise and resources, CMRA also appears to be of value for exclusion of severe proximal multivessel CAD in selected patients. Data from multicenter trials will continue to define the clinical role of CMRA, particularly as it relates to assessment of CAD. Future developments and enhancements of CMRA promise better lumen and coronary artery wall imaging. This may become the new target in noninvasive evaluation of CAD.
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Affiliation(s)
- Peter G Danias
- Harvard-Thorndike Laboratory of the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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27
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Knuesel PR, Nanz D, Wolfensberger U, Saranathan M, Lehning A, Luescher TF, Marincek B, von Schulthess GK, Schwitter J. Multislice breath-hold spiral magnetic resonance coronary angiography in patients with coronary artery disease: effect of intravascular contrast medium. J Magn Reson Imaging 2002; 16:660-7. [PMID: 12451579 DOI: 10.1002/jmri.10202] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE First, to apply a breath-hold multislice 2D spiral magnetic resonance (MR) approach in patients acquiring within 16 heartbeats (acquisition window, 116 msec) a 10-mm-thick stack of four slices (resolution, 1.3 x 1.3 mm(2)); and second, to evaluate the effect of an intravascular Fe-based contrast medium (CM) on a signal-to-noise ratio (SNR) and a contrast-to-noise ratio (CNR). MATERIALS AND METHODS In each patient one or two coronary arteries were imaged prior to and following cumulative doses of 0.25, 0.5, and 0.75 mg of Fe/kg of body weight (bw) of an intravascular CM (CLARISCAN trade mark, Nycomed-Amersham, Princeton, NJ, USA) containing ultrasmall superparamagnetic iron oxide (USPIO) particles. RESULTS On precontrast maximum intensity projection (MIP) images generated from the stack of slices, 10 and 11 stenoses of 12 stenoses confirmed by coronary angiography were detected by readers 1 and 2, respectively. SNR and CNR in the coronary arteries peaked at 0.50 mg of Fe/kg of bw, yielding a slight increase of 15.5% and 18.4%, respectively (P < 0.05 vs. precontrast), which did not improve detection of coronary artery stenoses. CONCLUSION The presented multislice spiral approach allows display of coronary anatomy in MIP formats for convenient display of coronary stenoses. The pulse sequence did not benefit from an intravascular USPIO-based CM, since little improvement in SNR and CNR was achieved.
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Affiliation(s)
- Patrick R Knuesel
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
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28
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Hietschold V, Abolmaali N, Kittner T. MRI of the coronary arteries: flip angle train optimization for 3D sequences. Z Med Phys 2002; 12:177-81. [PMID: 12375451 DOI: 10.1016/s0939-3889(15)70465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Application of contrast agents in MRI of coronary arteries improves contrast-to-noise ratio (CNR), but widens the range of T1 relaxation times of the tissues to be imaged. The flip angle train, generated for the measurement of all phase-encoding steps in the 3rd spatial dimension of the navigator echo FLASH sequence used, is optimal only for one T1. Computer simulations show that it is not advisable to optimize the sequence on the basis of an extremely short T1 relaxation time (such as in the case of contrast-enhanced vessels) because the imaging of the surrounding tissue would be negatively influenced. A sequence optimization to a T1 of approximately 200 ms seems to allow a CNR improvement of > or = 50%.
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Affiliation(s)
- Volker Hietschold
- Institut und Poliklinik für Radiologische Diagnostik, Technische Universität Dresden
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29
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Fayad ZA, Fuster V, Nikolaou K, Becker C. Computed tomography and magnetic resonance imaging for noninvasive coronary angiography and plaque imaging: current and potential future concepts. Circulation 2002; 106:2026-34. [PMID: 12370230 DOI: 10.1161/01.cir.0000034392.34211.fc] [Citation(s) in RCA: 209] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zahi A Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.
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30
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Regenfus M, Ropers D, Achenbach S, Schlundt C, Kessler W, Laub G, Moshage W, Daniel WG. Comparison of contrast-enhanced breath-hold and free-breathing respiratory-gated imaging in three-dimensional magnetic resonance coronary angiography. Am J Cardiol 2002; 90:725-30. [PMID: 12356385 DOI: 10.1016/s0002-9149(02)02598-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Suppression of respiratory motion is one of the major challenges of magnetic resonance (MR) coronary angiography. Two approaches to compensate for respiratory motion have often been proposed: breath-hold (BH) and free-breathing respiratory-gated (FBRG) imaging. So far, however, these approaches have never been directly compared. MR coronary angiography was performed in 32 patients with suspected coronary artery disease. MR data were acquired using contrast-enhanced BH and FBRG 3-dimensional MR coronary angiographic techniques. MR images were compared with regard to image quality using quantitative parameters and with regard to accuracy for stenosis detection in the proximal and mid-coronary segments in comparison to x-ray angiography. With regard to image quality, BH was superior to FBRG. Signal-to-noise ratio was 29.1 +/- 10.7 for BH versus 18.8 +/- 9.7 for FBRG (p <0.05) and contrast-to-noise was 18.0 +/- 7.4 for BH versus 11.3 +/- 7.9 for FBRG (p </=0.05). One hundered seventy-one of 224 coronary artery segments (76%) were evaluable in BH compared with 155 of 224 in FBRG (69%). In the evaluable segments, BH demonstrated a sensitivity of 87% (26 of 30 stenoses detected) and specificity of 92% (129 of 141 nonstenotic segments correctly identified), whereas FBRG showed a sensitivity of 60% (15 of 25) and specificity of 89% (115 of 130). Overall accuracy was 91% (155 of 171) for BH and 84% (130 of 155) for FBRG. Sensitivity was significantly higher for BH (p = 0.0320), whereas specificity and overall accuracy were not significantly different. Thus, contrast-enhanced BH MR coronary angiography compares favorably to FBRG imaging with regard to image quality and detection of coronary stenoses.
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Affiliation(s)
- Matthias Regenfus
- Department of Internal Medicine II, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen, Germany.
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31
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Watanabe Y, Nagayama M, Amoh Y, Fujii M, Fuku Y, Okumura A, Van Cauteren M, Stuber M, Dodo Y. High-resolution selective three-dimensional magnetic resonance coronary angiography with navigator-echo technique: segment-by-segment evaluation of coronary artery stenosis. J Magn Reson Imaging 2002; 16:238-45. [PMID: 12205578 DOI: 10.1002/jmri.10156] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate the feasibility of high-resolution selective three-dimensional (3D) magnetic resonance coronary angiography (MRCA) in the evaluation of coronary artery stenoses. MATERIALS AND METHODS In 12 patients with coronary artery stenoses, MRCA of the coronary artery groups, including the coronary segments with stenoses of 50% or greater based on conventional x-ray coronary angiography (CAG), was performed with double-oblique imaging planes by orienting the 3D slab along the major axis of each right coronary artery-left circumflex artery (RCA-LCX) group and each left main trunk-left anterior descending artery (LMT-LAD) group. Ten RCA-LCX and five LMT-LAD MR angiograms were obtained, and the results were compared with those of conventional x-ray angiography. RESULTS Among 70 coronary artery segments expected to be covered, a total of 49 (70%) segments were fully demonstrated in diagnostic quality. The identification of segmental location of stenoses showed as high an accuracy as 96%. The retrospective analysis for stenosis of 50% or greater yielded the sensitivity, specificity, and accuracy of 80%, 85%, and 84%, respectively. CONCLUSION Selective 3D MRCA has the potential for segment-by-segment evaluation of major portions of the right and left coronary arteries with high accuracy.
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Affiliation(s)
- Yuji Watanabe
- Department of Radiology, Kurashiki Central Hospital, Miwa, Kurashiki, Japan.
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32
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Ropers D, Regenfus M, Stilianakis N, Birke S, Kessler W, Moshage W, Laub G, Daniel WG, Achenbach S. A direct comparison of noninvasive coronary angiography by electron beam tomography and navigator-echo-based magnetic resonance imaging for the detection of restenosis following coronary angioplasty. Invest Radiol 2002; 37:386-92. [PMID: 12068160 DOI: 10.1097/00004424-200207000-00005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To compare electron beam tomography (EBT) with MR imaging (MRI) for detection of restenosis after coronary angioplasty (PTCA). METHODS One hundred eighteen patients after PTCA were investigated. By EBT, 50 axial images were acquired (3-mm slice thickness, 120-160 mL radiographic contrast agent). MRI was performed using respiratory-gated sequences (24-48 cross-sections, 2-mm slice thickness, 20 mL Gd-DTPA). EBT and MRI images were evaluated concerning high-grade post-PTCA restenosis (> or = 70%) and validated against coronary angiography. RESULTS In EBT, 28 patients and in MRI, 31 patients were not evaluable. In the remaining patients, sensitivity for restenosis detection was 90% in EBT (17/19) and 73% in MRI (11/15; P = 0.370). In EBT, specificity was significantly higher (66% vs. 49%, P = 0.043). Overall accuracy was 71% for EBT and 53% for MRI (P = 0.014). CONCLUSIONS For the detection of high-grade restenosis after PTCA, EBT demonstrated significantly higher accuracy than MRI.
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Affiliation(s)
- Dieter Ropers
- Department of Internal Medicine, Biometry, and Epidemiology, University of Erlangen-Nuernberg, Erlangen, Germany.
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33
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Holland AE, Engelbrecht MR, Barentsz JO, Heijstraten FMJ, Goldfarb JW. The value of single-shot black-blood MR imaging for mapping of the coronary arteries: a comparison of four different orientations during breath-holding and free breathing. Magn Reson Imaging 2002; 20:261-9. [PMID: 12117608 DOI: 10.1016/s0730-725x(02)00492-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The value of ECG-gated single-shot black-blood MR imaging for rapid visualization of the origin and course of the coronary arteries was investigated. The study population included 28 patients with known or suspected cardiac disease. ECG-gated single-shot black-blood MR acquisitions were acquired in the transverse, coronal, sagittal and LAO orientations, during free breathing and breath-holding. The origin of the left coronary artery was most frequently visualized in the coronal and LAO orientations and the origin of the right coronary artery was most frequently visualized in the LAO orientation. Overall, no significant difference was found for the visualization of the coronary artery segments and the overall image quality among acquisitions during breath-holding and free breathing. ECG-gated single-shot black-blood MR imaging (HASTE) appears to be a time-efficient and robust method for mapping of the entire coronary artery tree, without the need for breath-holding. The LAO orientation provides the most consistent visualization of the origins and major coronary artery segments.
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Affiliation(s)
- Agnes E Holland
- Department of Radiology, University Hospital Nijmegen, The, Nijmegen, Netherlands.
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Bunce NH, Jhooti P, Keegan J, Rahman SL, Bunce C, Firmin DN, Davies SW, Lorenz CH, Pennell DJ. Evaluation of free-breathing three-dimensional magnetic resonance coronary angiography with hybrid ordered phase encoding (HOPE) for the detection of proximal coronary artery stenosis. J Magn Reson Imaging 2001; 14:677-84. [PMID: 11747023 DOI: 10.1002/jmri.10013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We evaluated free-breathing, prospective navigator-gated, three-dimensional (3D) magnetic resonance coronary angiography (MRCA) with hybrid ordered phase-encoding (HOPE), in the detection of proximal coronary artery stenosis. The coronary arteries were imaged in 46 patients undergoing cardiac catheterization. The mean scan time was 48 minutes. The mean arterial length (mm) visualized was left main stem (LMS) 11.7 (SD 4.5), left anterior descending (LAD) 30.1 (SD 11.1), circumflex (LCx) 15.5 (SD 8.6), and right (RCA) 56.2 (SD 20.8). Twenty-three patients had coronary artery disease with 47 significant stenoses on cardiac catheterization. All LMS were normal on both catheterization and MRCA. MRCA sensitivity was highest for the LAD (89% CI 65%-99%) and RCA (76% CI 50%-93%), but lower for the LCx (50% CI 21%-79%). Specificity ranged from 72%-100%. Improvements in image quality, length of vessel seen, and specific imaging of the LCx are required for MRCA to become an alternative to cardiac catheterization.
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Affiliation(s)
- N H Bunce
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
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35
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Taupitz M, Schnorr J, Wagner S, Kivelitz D, Rogalla P, Claassen G, Dewey M, Robert P, Corot C, Hamm B. Coronary magnetic resonance angiography: experimental evaluation of the new rapid clearance blood pool contrast medium P792. Magn Reson Med 2001; 46:932-8. [PMID: 11675645 DOI: 10.1002/mrm.1279] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The signal-enhancing characteristics of a new monodisperse monogadolinated macromolecular MR contrast medium (P792) were evaluated for magnetic resonance angiography (MRA) of the coronary arteries. A total of 15 cardiac examinations were performed in pigs at 1.5 T using a 3D gradient-echo sequence. Images were acquired during breath-hold before and up to 35 min after IV injection of Gd-DTPA (0.3 mmol Gd/kg), Gd-BOPTA (0.2 mmol Gd/kg), and P792 (13 micromol Gd/kg). An increase in the signal-to-noise ratio (SNR) of 97% +/- 17%, 108% +/- 37%, and 109% +/- 31% in coronary arteries and of 82% +/- 19%, 82% +/- 24%, and 28% +/- 18% in myocardium, respectively, was measured during the first postcontrast acquisition. The blood-to-myocardium signal-difference-to-noise ratio (SDNR) was significantly higher for P792 than for the other Gd compounds (P <.05) for up to 15 min after injection. Qualitative assessment showed that visualization of the coronary arteries and their branches was significantly better for P792 compared to the low-molecular Gd compounds (P <.05). The blood pool contrast medium P792 is well suited for MRA of the coronary arteries.
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Affiliation(s)
- M Taupitz
- Department of Radiology, Charité, Medizinische Fakultät, Humboldt-Universität zu Berlin, Berlin, Germany.
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Mao S, Budoff MJ, Bin L, Liu SC. Optimal ECG trigger point in electron-beam CT studies: three methods for minimizing motion artifacts. Acad Radiol 2001; 8:1107-15. [PMID: 11721810 DOI: 10.1016/s1076-6332(03)80722-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The authors hypothesized that electrocardiographic triggering near end systole could minimize motion artifacts in electron-beam computed tomography (CT) of the coronary artery. MATERIALS AND METHODS The study included 2,660 patients who underwent coronary artery calcium scanning with electron-beam CT. Trigger times were as follows: end of T wave, 120 to 25 msec before end of T wave, 25-50 msec after end of T wave, 40%, 45%, 50%, 55%, 60%, 70%, 75%, 80%, 90%, and 100% of R-R interval. The authors divided each group into seven subgroups according to heart rate. The percentages of cases with motion artifact in the right coronary artery were computed. Optimal trigger times were defined for each group, as well as for scan acquisitions of 250 and 200 msec. RESULTS The optimal trigger times were as follows for heart rates of less than 50, 51-60, 61-70, 71-80, 81-90, 91-100, and more than 100 beats per minute, respectively: for 100-msec scans, 359 (27% of the R-R interval), 228 (31%), 314 (34%), 304 (38%), 289 (41%), 283 (45%), and 274 msec (48%) after the R wave; for 250-msec scans, 840 (63%), 654 (60%), 240 (26%), 224 (28%), 219 (31%), 208 (33%), and 200 msec (35%) after the R wave; and for 200-msec scans, 722 (65%), 687 (63%), 249 (27%), 248 (31%), 244 (35%), 233 (37%), and 223 msec (39%) after the R wave. CONCLUSION The use of these new electrocardiographic triggers before end systole yielded the lowest percentage of motion artifacts (<3% across all heart rates), much lower than for conventional triggers (51% of cases with motion artifact for 80% trigger, P < .001).
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Affiliation(s)
- S Mao
- Harbor-UCLA Research and Education Institute, Torrance, CA 90502, USA
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37
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Abstract
Modern level of cardiac magnetic resonance imaging (MRI) development already allows its routine use (with proper indications) in coronary heart disease patients for studies of heart morphology and functions, performance of stress tests for evaluation of myocardial perfusion and contractile function. Coronary MRA and some other new MR techniques are close to its wide-scale clinical application. It has been shown that cardiac MRI is a valuable tool for detection of postinfarction scars, aneurysms, pseudoaneurysms, septal defects, mural thrombi and valvular regurgitations. Due to intrinsic advantages of the method it is of special value when these pathological conditions cannot be fully confirmed or excluded with echocardiography. MRI is recognized as the best imaging method for quantification of myocardial thickness, myocardial mass, systolic myocardial thickening, chamber volumes, ejection fraction and other parameters of global and regional systolic and diastolic function. MRI is used in studies of cardiac remodeling in postinfarction patients. The most attractive areas for cardiovascular applications of MRI are assessment of myocardial perfusion and non-invasive coronary angiography. Substantial progress has been achieved in these directions. There are some other new developments in studies of coronary artery disease with MRI. High-resolution MR is used for imaging and quantification of atherosclerotic plaque composition in vivo. Intravascular MR devices suitable for performing imaging-guided balloon angioplasty are created. But before MRI will be widely accepted by the medical community as a important cardiovascular imaging modality several important problems have to be solved. Further technical advances are necessary for clinical implementation of all major diagnostic capabilities of cardiac MRI. The subjective obstacles for growth of clinical applications of cardiac MRI are lack of understanding of its possibilities and benefits both by clinicians and radiologists themselves. So proper training of specialists and promotion of this promising modality among the medical community are necessary.
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Affiliation(s)
- V Sinitsyn
- Department of Tomography, Cardiology Research Center, 3d Cherepkovskaya Street 15a, 121552, Moscow, Russia.
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38
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Grollman JH, Kamin PD. Cardiac catheterization laboratories: do they have a future in diagnosis. Catheter Cardiovasc Interv 2001; 53:46-7. [PMID: 11329217 DOI: 10.1002/ccd.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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39
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Funabashi N, Rubin GD. Direct Identification of Patency Achieved by a Bi-Directional Glenn Shunt Procedure. Images by Volume Rendering Using Electron-Beam Computed Tomography. ACTA ACUST UNITED AC 2001; 65:457-61. [PMID: 11348053 DOI: 10.1253/jcj.65.457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study aimed to identify the patency achieved by a bi-directional Glenn shunt procedure by shaded volume rendering (VR) images using electron-beam computed tomography (EBCT). A Damus Kay-Stanzel type procedure was performed on a female with hypoplastic left heart syndrome who later received a bi-directional Glenn shunt to increase pulmonary blood flow. In considering the characteristics of the bi-directional Glenn shunt procedure, in which the superior vena cava is connected to the right pulmonary artery, an early phase acquisition protocol with injection of contrast material from the right cubital vein using the step volume scan mode of EBCT was planned to acquire blood flow information. Excellent spatial resolution volume data of the heart and great vessels was obtained from which 3-dimensional images were made. Bi-directional Glenn shunt flow could be observed directly and the complex morphology and relationships between adjacent structures were revealed by 3-dimensional VR imaging. The combination of EBCT and VR can provide useful information to evaluate congenital heart diseases.
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Affiliation(s)
- N Funabashi
- The Third Department of Internal Medicine, Chiba University, Chiba-city, Japan
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40
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Foo TK, Saranathan M, Hardy CJ, Ho VB. Coronary artery magnetic resonance imaging: a patient-tailored approach. Top Magn Reson Imaging 2000; 11:406-16. [PMID: 11153707 DOI: 10.1097/00002142-200012000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Coronary artery magnetic resonance imaging strategies have tended to focus on the use of a single method performed during either breath-holding or free-breathing for all patients. However, significant variations exist among patients in terms of breath-holding ability and respiratory regularity that make the use of a single technique alone not universally successful. Therefore, it is prudent to make available a number of magnetic resonance imaging methods such that an appropriate respiratory motion reduction strategy can be tailored to suit the patient's respiratory pattern and characteristics. A tailored approach that can draw on different image acquisition techniques for coronary artery imaging is presented. A decision tree is proposed to triage patients into imaging regimes with the greatest probability of success, according to the patient's ability to breath-hold or exhibit steady respiration. Methods include volume free-breathing acquisitions using navigator echoes for respiratory monitoring in the 8- to 10-min scan time range, two-dimensional spiral navigators (2- to 3-min scan time), breath-held multislice and vessel-tracking spirals (16- to 20-second scan time), and real-time imaging approaches incorporating adaptive signal averaging. The development of multiple acquisition strategies substantially improves the opportunities to generate high-quality, diagnostic images of the coronary arteries.
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Affiliation(s)
- T K Foo
- Applied Science Laboratory, GE Medical Systems, Milwaukee, Wisconsin, USA
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41
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Funabashi N, Rubin GD. Qualitative blood flow differentiation: depiction of a left to right cardiac shunt across a ventricular septal defect using electron-beam computed tomography. JAPANESE CIRCULATION JOURNAL 2000; 64:901-3. [PMID: 11110440 DOI: 10.1253/jcj.64.901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Three-dimensional imaging using electron-beam computed tomography (EBCT) has been used to assess static anatomical information in heart disease. With volume rendering, differences in objects can be distinguished through selection of the shape of opacity and color curves for CT values. If there is a difference between the CT values for arterial and venous blood, differences in opacity and color between them can be set. In a newborn baby with a left to right cardiac shunt across the ventricular septal defect (VSD), EBCT could depict arterial blood crossing the VSD into the right ventricle.
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Affiliation(s)
- N Funabashi
- The Third Department of Internal Medicine, Chiba University, Chiba City, Japan
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Molinari G, Sardanelli F, Zandrino F, Balbi M, Masperone MA. Value of navigator echo magnetic resonance angiography in detecting occlusion/patency of arterial and venous, single and sequential coronary bypass grafts. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 2000; 16:149-60. [PMID: 11144768 DOI: 10.1023/a:1006432027712] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aim of our work was to validate magnetic resonance angiography (MRA) in detecting occlusion/patency of coronary artery bypass grafts. Twenty patients with previous history of bypass surgery and recurrent episodes of chest pain were enrolled. Two patients could not be studied (claustrophobia, erratic breathing). Thus, 18 patients with 51 bypasses were examined using a navigator echo sequence: 21 arterial grafts (six sequential) and 30 saphenous vein grafts (five sequential). All patients had undergone contrast conventional angiography 3-15 days before MRA. The magnetic resonance (MR) data set was analyzed by two independent readers blinded to the results of conventional angiography (occlusion of 12 of 51 grafts). At magnetic resonance, two bypasses of the posterior descending artery, patent at conventional angiography, could not be visualized because of imaging slab malpositioning. Interobserver concordance was 96% (47/49). Magnetic resonance and conventional angiography provided identical answers in 47 out of 49 (96%) of the examined grafts. Eleven out of 12 occluded grafts and 36 out of 37 patent grafts were correctly identified with MR. As far as occlusion is concerned, the sensitivity of MR was 91%, the specificity 97%. To summarize, a 30 min outpatient MR examination is highly reliable in determining occlusion/patency of arterial and venous, single and sequential bypasses.
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Affiliation(s)
- G Molinari
- Departments of Cardiology, University of Genoa School of Medicine, San Martino Hospital, Italy.
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