Coronary wall MR imaging in patients with rapid heart rates: a feasibility study of black-blood steady-state free precession (SSFP)

Abstract

We assessed the hypothesis that black-blood steady-state free precession (SSFP) would provide coronary wall images comparable to images from TSE and have better performance than TSE under conditions of fast heart rate. With IRB approval, thirty participants without a history of coronary artery disease (19 men, 11 women, 26-83 y/o) were scanned with a 1.5 T MR scanner. Cross-sectional black-blood images of the proximal portions of coronary arteries were acquired with a two-dimensional (2D), double inversion recovery (DIR) prepared TSE sequence and a 2D DIR SSFP sequence on the same planes. Image quality (ranked with a 4-point system, scored from 0 to 3), vessel wall area and thickness, signal-to-noise ratio (SNR) of the wall and contrast-to-noise ratio (CNR, wall to lumen) were compared between SSFP and TSE with SPSS software (v 13.0). Totally 28 scans were completed. For SSFP and TSE, there was no difference in image quality. SSFP had a higher SNR (23.7 ± 10.1 vs. 14.4 ± 5.2, P < 0.001) and wall-lumen CNR (8.8 ± 4.5 vs. 6.7 ± 3.2, P = 0.001). Good agreements between measured wall area (r = 0.701, P < 0.001) and thickness (r = 0.560, P < 0.001) were found. For 10 participants with heart rate more than 80 beats/min, the image quality of SSFP was higher than TSE (P = 0.016). SSFP provided image quality and measurement accuracy that was comparable to TSE. With its higher performance under fast heart rate conditions, SSFP may break through the existing thresholds for heart rate and extend clinical applicability of coronary wall MR imaging to a larger population.

Conflict of interest statement

Conflict of interest Two co-authors, XB and SZ, are employees of SIEMENS Healthcare. However, this study is under control of faculty/staff of Northwestern University.

Figures

Fig. 1

A 66 y/o male, heart rate 57 beats/min. The right coronary artery (RCA, grade 3) can easily be seen on both TSE (a) and SSFP (b)

Fig. 2

a SSFP had higher SNR (23.7 ± 10.1 vs. 14.4 ± 5.2, P < 0.001) and CNR (8.8 ± 4.5 vs. 6.7 ± 3.2, P < 0.001) than TSE. b Correlations between measured vessel wall area on SSFP versus TSE. Areas of vessel wall (Area of vessel-Area of lumen) was median correlated (r = 0.701, P < 0.001). c Bland–Altman plot of wall area measurements. d Wall thicknesses measured on SSFP versus TSE were median correlated (r = 0.560, P < 0.001). e Bland–Altman plot of wall thickness measurements

Fig. 3

A 76 y/o male with heart rate 88 beats/min. The rest period was 40 ms/cardiac cycle. a TSE: No coronary wall can be found. Grade 0. b SSFP: The left anterior descending coronary artery (LAD) can be seen clearly. Grade 3

Fig. 4

A 71 y/o male with heart rate 82 beats/min; rest period was 70 ms/cardiac cycle. a TSE: The left main coronary artery (LM) can be identified, but the border is not clear, and signal loss is seen. Grade 1. b SSFP: LM can be seen easily with a clear border. Grade 3