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. 1999 Oct;82(4):515–519. doi: 10.1136/hrt.82.4.515

Magnetic resonance imaging of the coronary arteries: clinical results from three dimensional evaluation of a respiratory gated technique

R J M van Geuns 1, H G de Bruin 1, B Rensing 1, P Wielopolski 1, M Hulshoff 1, P M A van Ooijen 1, M Oudkerk 1, P J de Feyter 1
PMCID: PMC1760261  PMID: 10490571

Abstract

BACKGROUND—Magnetic resonance coronary angiography is challenging because of the motion of the vessels during cardiac contraction and respiration. Additional challenges are the small calibre of the arteries and their complex three dimensional course. Respiratory gating, turboflash acquisition, and volume rendering techniques may meet the necessary requirements for appropriate visualisation.
OBJECTIVE—To determine the diagnostic accuracy of respiratory gated magnetic resonance imaging (MRI) for the detection of significant coronary artery stenoses evaluated with three dimensional postprocessing software.
METHODS—32 patients referred for elective coronary angiography were studied with a retrospective respiratory gated three dimensional gradient echo MRI technique. Resolution was 1.9 × 1.25 × 2 mm. After manual segmentation three dimensional evaluation was performed with a volume rendering technique.
RESULTS—Overall 74% (range 50% to 90%) of the proximal and mid coronary artery segments were visualised with an image quality suitable for further analysis. Sensitivity and specificity for the detection of significant stenoses were 50% and 91%, respectively.
CONCLUSIONS—Volume rendering of respiratory gated MRI techniques allows adequate visualisation of the coronary arteries in patients with a regular breathing pattern. Significant lesions in the major coronary artery branches can be identified with a moderate sensitivity and a high specificity.


Keywords: magnetic resonance imaging; coronary artery disease; coronary angiography; computer assisted image processing

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Figure 1  .

Figure 1  

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Retrospective respiratory gated magnetic resonance imaging of the coronary arteries. (A) Respiratory motion is determined by two excitation bands that intersected at the dome of the right hemidiaphragm. (B) Respiration pattern during 30 seconds. The diaphragm position is determined for each acquisition window. Retrospectively only data from end expiration are selected for image reconstruction.

Figure 2  .

Figure 2  

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Volume rendering of a patient without significant stenoses. (A) Cranial view of the left anterior descending coronary artery (LAD). The great cardiac vein (GCV) overlaps intermediate branches (RI), which hampers evaluation of this segment. (B) Corresponding conventional selective coronary angiogram. (C) Rotation to right cranial view for proximal right coronary artery (RCAp) between right ventricular outflow tract (RVOT) and right atrium (RA). The right auricle is manually removed from the data. (D) Rotation to right caudal view for distal right coronary artery (RCAd) and origin of posterior descending artery (PDA). Ao, aorta; LA, left atrium.

Figure 3  .

Figure 3  

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(A) Magnetic resonance imaging. Detailed view on the right coronary artery in the atrioventricular groove between the right ventricle (RV) and atrium (RA). The arrows indicate stenoses in the proximal and mid segment. (B) Corresponding conventional coronary angiogram.

Figure 4  .

Figure 4  

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Example of a significant stenosis (arrow head) in the left anterior descending coronary artery (LAD). (A) Conventional coronary angiogram. (B) Magnetic resonance imaging. Ao, aorta; LM, left main; LV, left ventricle; RVOT, right ventricular outflow tract.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Achenbach S., Kessler W., Moshage W. E., Ropers D., Zink D., Kroeker R., Nitz W., Laub G., Bachmann K. Visualization of the coronary arteries in three-dimensional reconstructions using respiratory gated magnetic resonance imaging. Coron Artery Dis. 1997 Jul;8(7):441–448. doi: 10.1097/00019501-199707000-00006. [DOI] [PubMed] [Google Scholar]
  2. Austen W. G., Edwards J. E., Frye R. L., Gensini G. G., Gott V. L., Griffith L. S., McGoon D. C., Murphy M. L., Roe B. B. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation. 1975 Apr;51(4 Suppl):5–40. doi: 10.1161/01.cir.51.4.5. [DOI] [PubMed] [Google Scholar]
  3. Danias P. G., McConnell M. V., Khasgiwala V. C., Chuang M. L., Edelman R. R., Manning W. J. Prospective navigator correction of image position for coronary MR angiography. Radiology. 1997 Jun;203(3):733–736. doi: 10.1148/radiology.203.3.9169696. [DOI] [PubMed] [Google Scholar]
  4. Duerinckx A. J., Atkinson D. P., Mintorovitch J., Simonetti O. P., Vrman M. K. Two-dimensional coronary MRA: limitations and artifacts. Eur Radiol. 1996;6(3):312–325. doi: 10.1007/BF00180601. [DOI] [PubMed] [Google Scholar]
  5. Duerinckx A. J., Urman M. K. Two-dimensional coronary MR angiography: analysis of initial clinical results. Radiology. 1994 Dec;193(3):731–738. doi: 10.1148/radiology.193.3.7972815. [DOI] [PubMed] [Google Scholar]
  6. Fishman E. K., Magid D., Ney D. R., Chaney E. L., Pizer S. M., Rosenman J. G., Levin D. N., Vannier M. W., Kuhlman J. E., Robertson D. D. Three-dimensional imaging. Radiology. 1991 Nov;181(2):321–337. doi: 10.1148/radiology.181.2.1789832. [DOI] [PubMed] [Google Scholar]
  7. Hofman M. B., Paschal C. B., Li D., Haacke E. M., van Rossum A. C., Sprenger M. MRI of coronary arteries: 2D breath-hold vs 3D respiratory-gated acquisition. J Comput Assist Tomogr. 1995 Jan-Feb;19(1):56–62. [PubMed] [Google Scholar]
  8. Johnson P. T., Heath D. G., Kuszyk B. S., Fishman E. K. CT angiography with volume rendering: advantages and applications in splanchnic vascular imaging. Radiology. 1996 Aug;200(2):564–568. doi: 10.1148/radiology.200.2.8685358. [DOI] [PubMed] [Google Scholar]
  9. Johnson P. T., Heath D. G., Kuszyk B. S., Fishman E. K. CT angiography: thoracic vascular imaging with interactive volume rendering technique. J Comput Assist Tomogr. 1997 Jan-Feb;21(1):110–114. doi: 10.1097/00004728-199701000-00022. [DOI] [PubMed] [Google Scholar]
  10. Judkins M. P. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967 Nov;89(5):815–824. doi: 10.1148/89.5.815. [DOI] [PubMed] [Google Scholar]
  11. Kessler W., Achenbach S., Moshage W., Zink D., Kroeker R., Nitz W., Laub G., Bachmann K. Usefulness of respiratory gated magnetic resonance coronary angiography in assessing narrowings > or = 50% in diameter in native coronary arteries and in aortocoronary bypass conduits. Am J Cardiol. 1997 Oct 15;80(8):989–993. doi: 10.1016/s0002-9149(97)00590-0. [DOI] [PubMed] [Google Scholar]
  12. Kuszyk B. S., Heath D. G., Ney D. R., Bluemke D. A., Urban B. A., Chambers T. P., Fishman E. K. CT angiography with volume rendering: imaging findings. AJR Am J Roentgenol. 1995 Aug;165(2):445–448. doi: 10.2214/ajr.165.2.7618574. [DOI] [PubMed] [Google Scholar]
  13. Lauffer R. B., Parmelee D. J., Dunham S. U., Ouellet H. S., Dolan R. P., Witte S., McMurry T. J., Walovitch R. C. MS-325: albumin-targeted contrast agent for MR angiography. Radiology. 1998 May;207(2):529–538. doi: 10.1148/radiology.207.2.9577506. [DOI] [PubMed] [Google Scholar]
  14. Leung D. A., McKinnon G. C., Davis C. P., Pfammatter T., Krestin G. P., Debatin J. F. Breath-hold, contrast-enhanced, three-dimensional MR angiography. Radiology. 1996 Aug;200(2):569–571. doi: 10.1148/radiology.200.2.8685359. [DOI] [PubMed] [Google Scholar]
  15. Li D., Kaushikkar S., Haacke E. M., Woodard P. K., Dhawale P. J., Kroeker R. M., Laub G., Kuginuki Y., Gutierrez F. R. Coronary arteries: three-dimensional MR imaging with retrospective respiratory gating. Radiology. 1996 Dec;201(3):857–863. doi: 10.1148/radiology.201.3.8939242. [DOI] [PubMed] [Google Scholar]
  16. Manning W. J., Li W., Boyle N. G., Edelman R. R. Fat-suppressed breath-hold magnetic resonance coronary angiography. Circulation. 1993 Jan;87(1):94–104. doi: 10.1161/01.cir.87.1.94. [DOI] [PubMed] [Google Scholar]
  17. Müller M. F., Fleisch M., Kroeker R., Chatterjee T., Meier B., Vock P. Proximal coronary artery stenosis: three-dimensional MRI with fat saturation and navigator echo. J Magn Reson Imaging. 1997 Jul-Aug;7(4):644–651. doi: 10.1002/jmri.1880070406. [DOI] [PubMed] [Google Scholar]
  18. Pennell D. J., Keegan J., Firmin D. N., Gatehouse P. D., Underwood S. R., Longmore D. B. Magnetic resonance imaging of coronary arteries: technique and preliminary results. Br Heart J. 1993 Oct;70(4):315–326. doi: 10.1136/hrt.70.4.315. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Post J. C., van Rossum A. C., Hofman M. B., Valk J., Visser C. A. Protocol for two-dimensional magnetic resonance coronary angiography studied in three-dimensional magnetic resonance data sets. Am Heart J. 1995 Jul;130(1):167–173. doi: 10.1016/0002-8703(95)90252-x. [DOI] [PubMed] [Google Scholar]
  20. Post J. C., van Rossum A. C., Hofman M. B., Valk J., Visser C. A. Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography. AJR Am J Roentgenol. 1996 Jun;166(6):1399–1404. doi: 10.2214/ajr.166.6.8633453. [DOI] [PubMed] [Google Scholar]
  21. Prince M. R., Narasimham D. L., Stanley J. C., Chenevert T. L., Williams D. M., Marx M. V., Cho K. J. Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. Radiology. 1995 Dec;197(3):785–792. doi: 10.1148/radiology.197.3.7480757. [DOI] [PubMed] [Google Scholar]
  22. Rensing B. J., Bongaerts A., van Geuns R. J., van Ooijen P., Oudkerk M., de Feyter P. J. Intravenous coronary angiography by electron beam computed tomography: a clinical evaluation. Circulation. 1998 Dec 8;98(23):2509–2512. doi: 10.1161/01.cir.98.23.2509. [DOI] [PubMed] [Google Scholar]
  23. Taylor A. M., Jhooti P., Wiesmann F., Keegan J., Firmin D. N., Pennell D. J. MR navigator-echo monitoring of temporal changes in diaphragm position: implications for MR coronary angiography. J Magn Reson Imaging. 1997 Jul-Aug;7(4):629–636. doi: 10.1002/jmri.1880070404. [DOI] [PubMed] [Google Scholar]
  24. Wang Y., Rossman P. J., Grimm R. C., Riederer S. J., Ehman R. L. Navigator-echo-based real-time respiratory gating and triggering for reduction of respiration effects in three-dimensional coronary MR angiography. Radiology. 1996 Jan;198(1):55–60. doi: 10.1148/radiology.198.1.8539406. [DOI] [PubMed] [Google Scholar]
  25. Wielopolski P. A., van Geuns R. J., de Feyter P. J., Oudkerk M. Breath-hold coronary MR angiography with volume-targeted imaging. Radiology. 1998 Oct;209(1):209–219. doi: 10.1148/radiology.209.1.9769834. [DOI] [PubMed] [Google Scholar]
  26. Woodard P. K., Li D., Haacke E. M., Dhawale P. J., Kaushikkar S., Barzilai B., Braverman A. C., Ludbrook P. A., Weiss A. N., Brown J. J. Detection of coronary stenoses on source and projection images using three-dimensional MR angiography with retrospective respiratory gating: preliminary experience. AJR Am J Roentgenol. 1998 Apr;170(4):883–888. doi: 10.2214/ajr.170.4.9530027. [DOI] [PubMed] [Google Scholar]
  27. van Rossum A. C., Post J. C., Visser C. A. Coronary imaging using MRI. Herz. 1996 Apr;21(2):97–105. [PubMed] [Google Scholar]

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