Contrast-enhanced whole-heart coronary magnetic resonance angiography at 3.0-T: a comparative study with X-ray angiography in a single center

Abstract

Objectives: The purpose of this study was to prospectively evaluate the diagnostic performance of 3.0-T contrast-enhanced whole-heart coronary magnetic resonance angiography (CMRA) in patients with suspected coronary artery disease (CAD).

Background: A slow-infusion, contrast-enhanced whole-heart CMRA approach has recently been developed at 3.0-T. The accuracy of this technique has not yet been determined among patients with suspected CAD.

Methods: The 3.0-T contrast-enhanced whole-heart CMRA was performed in 69 consecutive patients. An electrocardiography-triggered, navigator-gated, inversion-recovery prepared, segmented gradient-echo sequence was used to acquire isotropic whole-heart CMRA with slow infusion of 0.2 mmol/kg gadobenate dimeglumine. The diagnostic accuracy of whole-heart CMRA in detecting significant stenoses (> or =50%) was evaluated using X-ray angiography as the reference.

Results: The CMRA examinations were successfully completed in 62 patients. Acquisition time of whole-heart CMRA procedure was 9.0 +/- 1.9 min. The 3.0-T whole-heart CMRA correctly identified significant CAD in 32 patients and correctly ruled out CAD in 23 patients. The sensitivity, specificity, and accuracy of whole-heart CMRA for detecting significant stenoses were 91.6% (87 of 95), 83.1% (570 of 686), and 84.1% (657 of 781), respectively, on a per-segment basis. These values were 94.1% (32 of 34), 82.1% (23 of 28), and 88.7% (55 of 62), respectively, on a per-patient basis.

Conclusions: Contrast-enhanced whole-heart CMRA with 3.0-T allows for the accurate detection of coronary artery stenosis with high sensitivity and moderate specificity.

Figures

Figure 1. Flow chart of patient inclusion

CAD = Coronary Artery Disease. CMRA = Magnetic Resonance Coronary Angiography.

Figure 2. 3T contrast-enhanced whole-heart CMRA images of a 71 year-old woman with normal coronary arteries

A. Volume rendered (VR) image providing an overview of coronary anatomy, clearly depicts RCA, LAD and diagonal branches. B. Curved MPR image using CoronaViz software shows LM, LAD, LCX and RCA

Figure 2. 3T contrast-enhanced whole-heart CMRA images of a 71 year-old woman with normal coronary arteries

A. Volume rendered (VR) image providing an overview of coronary anatomy, clearly depicts RCA, LAD and diagonal branches. B. Curved MPR image using CoronaViz software shows LM, LAD, LCX and RCA

Figure 3. 3T contrast-enhanced whole-heart CMRA images of a 54 year-old female patient

MIP image (A) of MRA detects a significant stenosis in the middle RCA (arrow) with good correlation with x-ray angiography (B). Both readers interpreted this as significant stenosis based on CMRA images.

Figure 3. 3T contrast-enhanced whole-heart CMRA images of a 54 year-old female patient

MIP image (A) of MRA detects a significant stenosis in the middle RCA (arrow) with good correlation with x-ray angiography (B). Both readers interpreted this as significant stenosis based on CMRA images.

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).

Figure 4. 3T contrast-enhanced whole-heart CMRA images of a 75 year-old male patient with atypical chest pain

CMRA MIP images (A and B) show a significant stenosis in the proximal LCX and a non-significant stenosis in the middle RCA (arrows), respectively. VR images (syngo InSpace, Siemens AG Healthcare, Erlangen, Germany) (C and D)have the same findings in LCX and RCA, which were consistent with the conventional coronary angiography (E and F).