OBJECTIVESWe sought to determine the diagnostic performance of whole-heart coronary magnetic resonance (MR) angiography for detecting significant coronary artery disease. BACKGROUND The accuracy of whole-heart coronary MR angiography has not been determined in a large number of patients. METHODSThree-dimensional coronary MR angiograms covering the entire heart were obtained during free breathing in 131 patients. Images were acquired during a patient-specific time window in the cardiac cycle with minimal motion of the coronary artery. Significant coronary artery disease was defined on X-ray coronary angiography as a diameter reduction of Ն50% in coronary arteries with a reference diameter of Ն2 mm. RESULTSThe acquisition of MR angiography was completed in 113 (86%) of 131 patients, with an imaging time averaged at 12.9 Ϯ 4.3 min. On a patient-based analysis, the sensitivity, specificity, positive and negative predictive value, and accuracy of MR angiography were 82% (95% confidence interval [CI] 69% to 91%), 90% (95% CI 79% to 96%), 88% (95% CI 74% to 95%), 86% (95% CI 75% to 93%), and 87% (95% CI 79% to 92%), respectively. These values in the individual segments were 78% (95% CI 68% to 85%), 96% (95% CI 95% to 97%), 69% (95% CI 60% to 77%), 98% (95% CI 96% to 98%), and 94% (95% CI 96% to 96%). CONCLUSIONS Whole-heart coronary MR angiography allows for noninvasive detection of significant narrowing in coronary arterial segments with a diameter of Ն2 mm with moderate sensitivity and high specificity. (J Am Coll Cardiol 2006;48:1946 -50) A previous multicenter study demonstrated that 3-dimensional respiratory-gated coronary magnetic resonance (MR) angiography reliably identifies patients with left main coronary artery or 3-vessel disease (1). However, coronary MR angiography remains time-consuming because only a limited portion of the entire coronary arteries is imaged for each double-oblique acquisition. Whole-heart coronary MR angiography using a See page 1951free-breathing, 3-dimensional steady-state free precession sequence recently has been introduced as a method that can provide visualization of all 3 major coronary arteries (2-4).With this method, one can visualize long segments of major coronary vessels with reduced total examination time. However, the accuracy of whole-heart coronary MR angiography for detecting coronary stenoses has not been determined in a large number of patients. Consequently, we conducted a prospective study to investigate the diagnostic value of this method for the detection of obstructive coronary artery disease. METHODS Patients.During a period of 14 months from January 2004, 145 subjects were consecutively recruited from patients with suspected coronary artery disease who were scheduled for elective X-ray coronary angiography. Exclusion criteria included general contraindications to MR examination, unstable angina, atrial fibrillation, and previous coronary artery bypass graft surgery. Fourteen patients were excluded based on these exclusion criteria. Thus, the study population co...

This study had institutional review board approval, and all patients gave informed consent. The purpose of this study was to prospectively evaluate the use of whole-heart three-dimensional (3D) coronary magnetic resonance (MR) angiography in patients suspected of having coronary artery disease. Whole-heart coronary MR angiography was performed in 39 patients (30 men and nine women; mean age, 63.9 years +/- 15.6 [standard deviation]) by using a steady-state free precession sequence with free breathing. Twenty patients (16 men and four women; mean age, 64.9 years +/- 11.7) also underwent conventional coronary angiography. MR angiography was successfully completed in 34 of 39 patients (87%); the average imaging time was 13.8 minutes +/- 3.8. Sensitivity and specificity of MR angiography for detecting significant stenosis were 82% (14 of 17 arteries) and 91% (39 of 43 arteries), respectively. Whole-heart coronary MR angiography with a navigator-gated steady-state sequence can enable reliable 3D visualization of the coronary arteries in patients suspected of having coronary artery disease.

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The diagnostic accuracy of stress perfusion MRI acquired with saturation-recovery-prepared turbo FLASH was comparable with that of stress 201Tl SPECT. Stress first-pass contrast-enhanced MRI is a noninvasive technique that can be used as an alternative to stress myocardial perfusion scintigraphy.