To which extent can the coronary artery tree be imaged and quantified with the current MR technology?
Part of the
Developments in Cardiovascular Medicine
book series (DICM, volume 186)
Without use of ionizing radiation and injection of contrast material magnetic resonance (MR) imaging can be applied to generate signal from flowing blood and create tomographic images of the blood stream in coronary arteries, which resemble conventional contrast enhanced x-ray angiograms. The tortuosity, small diameter and motion of the coronary arteries provided technically demanding problems, which had to be solved before MR coronary angiography became realistic. Faster pulse sequences, dedicated radiofrequency receiver coils, cardiac and respiratory gating techniques were introduced and are still in the process of constant development to improve the quality of the images.
To date, most clinical experience has been obtained using two-dimensional (2D) approaches, necessitating repetitive breath-holds to encompass the coronary artery tree. A substantial part of the proximal and middle parts of the coronary arteries can be visualized, which has proven to be accurate in identifying anomalous coronary anatomy and patency of proximal coronary artery bypass grafts. With respect to detection of coronary artery disease, studies in limited numbers of patients indicate that the sensitivity for detection of stenoses > 50% of luminal diameter narrowing is high in left main disease, moderate in LAD and RCA disease, and low in LCX disease.
Another approach is a single acquisition respiratory gated three-dimensional (3D) technique which is less operator and patient dependent, requires less imaging time for an entire coronary protocol and is more comfortable for the patient than the 2D breath-hold approach. Initial experience demonstrates the capability to identify the major epicardial coronary vessels to at least a similar extent as with the 2D technique. But here too, further development is required to demonstrate coronary stenoses.
It can be envisaged that, although currently not apt to replace conventional coronary angiography, MR coronary angiography will become of use in the evaluation of specific, well defined clinical issues in coronary artery disease.
KeywordsMagnetic Resonance Angiography Leave Anterior Descend Right Coronary Artery Conventional Coronary Angiography Magnetic Resonance Coronary Angiography
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