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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.

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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