Double-oblique free-breathing high resolution three-dimensional coronary magnetic resonance angiography
Matthias Stuber, PhD*  ,
René M. Botnar, PhD* ,
Peter G. Danias, MD, PhD*,
Daniel K. Sodickson, MD, PhD*,
Kraig V. Kissinger, RT, MS*,
Marc Van Cauteren, PhD ,
Jan De Becker, PhD and
Warren J. Manning, MD* 
* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Philips Medical Systems, Best, The Netherlands
Philips Medical Systems, Tokyo, Japan
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Figure 1 Planning of the three-dimensional (3D) volume and the navigator (NAV) at the dome of the right hemidiaphragm (RHD). The images show a coronal (A) and a transverse (B) view as acquired during the first scout scan.
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Figure 2 Schematic of pulse sequences for three-dimensional (3D) scout scanning (Scout Scan) and high resolution 3D magnetic resonance (MR) angiography (HR-Scan), based on prospective navigator gating and real-time motion tracking. The elements of the sequence (T2-Prepulse, saturation prepulse [REST], navigator, fat saturation prepulse [FAT SAT] and the 3D imaging sequence) are shown in temporal relationship to the electrocardiogram and trigger delay.
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Figure 3 Definition of the double-oblique imaging plane for the right coronary artery (RCA). Transverse images at three different anatomic levels acquired with the three-dimensional TFE-EPI scout sequence are displayed. On all three levels, the user manually identifies the RCA (arrows).
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Figure 4 Angulations of the targeted imaged volume for the right coronary artery. Data of the healthy volunteers are displayed as empty triangles, and the data found in patients are displayed as solid circles. FH = foot–head angulation; LR = left–right angulation.
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Figure 5 Double-oblique free-breathing three-dimensional acquisition of the right coronary artery (RCA) of a healthy volunteer. The images A–D represent four adjacent slices from the 20-slice data set. The in-plane resolution is 0.7 x 1.0 mm, and the slice thickness is 1.5 mm. Image E shows a multiplanar reformatted image of the same data set where 140 mm of the contiguous RCA and 40 mm of the contiguous left circumflex coronary artery (LCX) are seen. Ao = aorta; LM = left main coronary artery; LV = left ventricle; PA = pulmonary artery; RA = right atrium.
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Figure 6 Three-dimensional reformatted images of the left and right coronary system in another healthy volunteer. The in-plane resolution in these images is 0.7 x 1.0 mm. Image A shows the right coronary artery (RCA), the sinus node branch (SN), an acute marginal right ventricle (RV), the left main coronary artery (LM) and the left circumflex coronary artery (LCX). In image B, The LM, the proximal LCX, a first diagonal (D1) and the left anterior descending coronary artery (LAD) are displayed. Ao = aorta; RVOT = right ventricular outflow tract.
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Figure 7 Three-dimensional reformatted coronary magnetic resonance angiography images of four additional healthy volunteers. In the upper panel (A–D), the right coronary artery is shown. The lower panel (E–H) displays the reformatted left main, left anterior descending and left circumflex coronary artery of the same participants.
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Figure 8 Comparison of a coronary magnetic resonance angiography (MRA) and the corresponding X-ray angiogram from a patient with right coronary artery (RCA) disease. Image A shows a coronary MRA of the RCA. In image B, a zoomed region of interest from image A is shown. Image C shows the X-ray angiogram from the same vessel. Local stenoses and their equivalents seen on the MR images are indicated with arrows.
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Figure 9 The same presentation as in Figure 8: magnetic resonance angiogram (A); X-ray angiogram (B) from another patient with a 90% diameter stenosis in the mid-right coronary artery (RCA) (solid arrow) and a 30% diameter stenosis in his proximal RCA (dotted arrow).
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Figure 10 Comparison of magnetic resonance angiogram (MRA) (A) and X-ray angiogram (B) of another patient with left coronary artery disease. The stenoses identified on the X-ray angiogram are indicated with arrows, and the corresponding locations are indicated on the MRA.
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