Delayed-Enhancement Cardiovascular Magnetic Resonance Coronary Artery Wall ImagingComparison With Multislice Computed Tomography and Quantitative Coronary Angiography
Susan B. Yeon, MD, JD, FACC*,*,
Adeel Sabir, MD ,
Melvin Clouse, MD,
Pedro O. Martinezclark, MD*,
Dana C. Peters, PhD*,
Thomas H. Hauser, MD, MMSc, MPH, FACC*,
C. Michael Gibson, MS, MD, FACC*,
Reza Nezafat, PhD*,
David Maintz, MD ,
Warren J. Manning, MD, FACC, FAHA*, and
René M. Botnar, PhD
* Department of Medicine (Cardiovascular Division)
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Department of Clinical Radiology, University of Muenster, Muenster, Germany
Department of Nuclear Medicine, Technical University Munich, Munich, Germany.
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Figure 1 Coronary MRI and Contrast-Enhanced Vessel Wall Scans for 4 Healthy Control Subjects Enrolled in the Study
No enhancement was observed in any of the control subjects, suggesting the absence of coronary atherosclerosis. Both the right (top rows) and left (bottom rows) coronary systems were imaged. Note the trivial pericardial effusion (arrowheads) adjacent to but distinguishable from the right coronary artery (RCA). DE-CMR = delayed-enhancement cardiovascular magnetic resonance; LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; MRI = magnetic resonance imaging.
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Figure 2 Data From a 46-Year-Old Subject With a Focal Luminal Stenosis in the Proximal RCA
Coronary magnetic resonance imaging (MRI) (A) and multislice computed tomography (MSCT) (B) show evidence of focal plaque burden (white arrows), with MSCT revealing a mixed calcified/noncalcified plaque. The corresponding X-ray angiogram (C) confirms this finding without providing information with regard to plaque burden or composition. In the lower row, a "hot spot" can be observed in the distal right coronary artery (RCA) on the precontrast delayed-enhancement cardiovascular magnetic resonance (DE-CMR) vessel wall scan (E), which may be due to thrombus or hemorrhage. Location of this spot is indicated on the identically formatted coronary MRI (D). On the corresponding X-ray angiogram (C), an abrupt change in lumen diameter can be observed suggestive of occlusion and/or thrombus. On the DE-CMR image (F), strong focal contrast uptake can be observed at the location of the proximal RCA stenosis (solid white arrows). Another focal hotspot is present at the midsection of the RCA where MSCT (B) reveals a mixed calcified/noncalcified plaque (dashed white arrows). CATH = X-ray coronary angiography.
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Figure 3 Patient Examples
A 59-year-old patient with no coronary disease demonstrated by X-ray evaluation. Coronary magnetic resonance imaging (MRI) (A), multislice computed tomography (MSCT) (D), and X-ray angiography (not shown) do not demonstrate coronary artery disease (A and D, black arrows). No focal enhancement was observed on noncontrast images (B), whereas moderate diffuse enhancement of the left main (LM), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCX) was found on postcontrast delayed-enhancement cardiovascular magnetic resonance (DE-CMR) images (arrows) (C). (H) A 59-year-old patient with MSCT, and X-ray (not shown) demonstrating evidence of disease in the proximal to mid-LCX. On MSCT, a mixed calcified/noncalcified LAD and a heavily calcified LCX plaque can be observed (black arrows; MSCT performed before intervention). Coronary MRI (E) is limited by the presence of stents in the proximal to mid-LCX, which resulted in local signal loss (single black arrow; MRI performed after intervention). On noncontrast DE-CMR (F), 2 hyperintense areas are visible just distal to the LCX stents (white dashed arrows); these hyperintense regions also are present on postcontrast DE-CMR (G, white dashed arrows). Diffuse contrast uptake is present in the entire LM and LAD (G, white arrows).
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Figure 4 Relationship Between Strong CMR Contrast Enhancement and MSCT Plaque
Prevalence of DE-CMR contrast enhancement increases with severity of coronary disease by MSCT along the spectrum from no plaque to noncalcified plaque to calcified plaque. DE-CMR = delayed-enhancement cardiovascular magnetic resonance; MR CE = magnetic resonance contrast enhancement; MSCT = multislice computed tomography.
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Figure 5 Relationship Between Strong DE-CMR Contrast Enhancement and X-Ray Angiographic Disease
Prevalence of severe DE-CMR contrast enhancement is higher in the presence of angiographic disease. CATH = X-ray coronary angiography; other abbreviations as in Figure 4.
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