CLINICAL STUDIES: CORONARY ARTERY DISEASE
Noninvasive detection of coronary artery stenosis using contrast-enhanced three-dimensional breath-hold magnetic resonance coronary angiography
Matthias Regenfus, MD*,
Dieter Ropers, MD*,
Stephan Achenbach, MD*,
Winfried Kessler, MD*,
Gerhard Laub, PhD ,
Werner G. Daniel, MD, FACC* and
Werner Moshage, MD*
* Department of Internal Medicine II, University of Erlangen-Nürnberg, Erlangen, Germany
Siemens Medical Engineering, Erlangen, Germany
Manuscript received May 6, 1999;
revised manuscript received December 30, 1999,
accepted February 28, 2000.
Reprint requests and correspondence: Dr. Matthias Regenfus, Department of Internal Medicine II, University of Erlangen-Nürnberg, Östliche Stadtmauerstrasse 29, 91054 Erlangen, Germany
dres.regenfus{at}t-online.de
OBJECTIVES
The purpose of this study was to evaluate a contrast-enhanced three-dimensional (3D) breath-hold magnetic resonance (MR) technique for detection of coronary artery stenoses.
BACKGROUND
The accuracy of previously published MR coronary angiography protocols varies widely. Recently, coronary artery imaging using T1-shortening contrast agent has become possible, but so far there are no data concerning its clinical application.
METHODS
Magnetic resonance coronary angiography was performed in 50 patients with suspected coronary artery disease. Magnetic resonance data acquisition using an ultrafast 3D gradient-echo sequence lasted over 32 heartbeats within one single breath-hold. Twenty milliliters of gadopentetate dimeglumine was injected at a flow rate of 1 ml/s for two successive studies covering the main coronary arteries in single-oblique planes. Stenosis assessment by MR was compared with significant (diameter stenosis > 50%) stenoses on X-ray angiography. Evaluation was limited to the proximal and mid-coronary artery segments.
RESULTS
Two hundred sixty-eight of 350 artery segments (76.6%) could be evaluated. Left circumflex coronary artery was only evaluable in 50% of cases by MR. In the evaluable segments, 48 of 56 stenoses and 193 of 212 nonstenotic segments were correctly classified by MR. On a patient basis, MR correctly identified 34 of 36 patients with and 8 of 14 patients without significant coronary stenoses as demonstrated by X-ray angiography (sensitivity 94.4%, specificity 57.1%).
CONCLUSIONS
Oblique projection contrast-enhanced MR coronary angiograms obtained within one single breath-hold permit identification of patients with coronary stenoses in the proximal and mid segments of the major coronary arteries with satisfactory accuracy.
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Abbreviations and Acronyms
| | FLASH | = fast low angle shot | | HASTE | = half-fourier turbo spin echo | | LAD | = left anterior descending coronary artery | | LCX | = left circumflex coronary artery | | LM | = left main coronary artery | | MR | = magnetic resonance | | RCA | = right coronary artery | | SNR | = signal-to-noise ratio | | TE | = echo time | | 3D | = three-dimensional | | TR | = repetition time | | 2D | = two-dimensional |
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