CLINICAL STUDY
Spiral magnetic resonance coronary angiography with rapid real-time localization
Phillip C. Yang, MD*,*,
Craig H. Meyer, PhD ,
Masahiro Terashima, MD*,
Shuichiro Kaji, MD*,
Michael V. McConnell, MD*,
A. l Macovski, PhD ,
John M. Pauly, PhD ,
Dwight G. Nishimura, PhD and
Bob S. Hu, MD*
* Division of Cardiovascular Medicine, Department of Medicine, Stanford, California, USA
Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA
Manuscript received April 2, 2002;
revised manuscript received November 19, 2002,
accepted November 27, 2002.
* Reprint requests and correspondence: Dr. Phillip C. Yang, Stanford University Medical Center, 300 Pasteur Drive, Room H-2157, Stanford, California 94305-5233, USA. pyang{at}cvmed.stanford.edu
OBJECTIVES: A spiral high-resolution coronary artery imaging sequence (SH) interfaced with real-time localization system (RT) has been developed. A clinical study of 40 patients suspected of coronary artery disease (CAD) was conducted.
BACKGROUND: Segmented k-space acquisition techniques have dominated magnetic resonance coronary angiography (MRCA) over the last decade. Although a recent multicenter trial using this technique demonstrated encouraging results, the technique was hampered by low specificity. Spiral k-space acquisition had demonstrated several advantages for MRCA. Therefore, a first clinical trial implementing spiral high-resolution coronary imaging sequence with real-time localization (SH-RT) was performed.
METHODS: A clinical study of 40 patients suspected of CAD undergoing X-ray angiography was conducted to analyze the clinical reliability of this novel imaging system. The SH-RT had been designed to exploit the unique capability of two imaging sequences. The RT allowed a rapid localization of the coronary arteries. Then SH achieved multislice acquisition during a short breath-hold with submillimeter resolution. The MRCA data were analyzed for scan time, anatomic coverage, image quality, and accuracy in detecting CAD.
RESULTS: In 40 subjects, SH achieved 0.7 to 0.9 mm resolution with 14-heartbeat breath-holds. Excellent or good image quality was achieved in 78% (263/337) of the coronary segments. Blinded consensus reading among three observers generated sensitivity of 76% and specificity of 91% in the detection of CAD compared with X-ray angiography.
CONCLUSIONS: The MRCA imaging sequence implementing a novel spiral k-space acquisition technique enabled rapid and reliable imaging of the CAD in submillimeter resolution with short breath-holds.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CNR | = contrast-to-noise ratio | | FOV | = field of view | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex coronary artery | | LMCA | = left main coronary artery | | MRCA | = magnetic resonance coronary angiography | | RCA | = right coronary artery | | RT | = real-time localization system | | SH | = spiral high-resolution coronary artery imaging sequence | | SNR | = signal-to-noise ratio |
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