Assessment of coronary artery stenosis by magnetic resonance imaging.

Abstract

Objective-The findings of magnetic resonance and x-ray angiography were compared for assessment of coronary artery stenosis in this validation study. Background-Magnetic resonance angiography of the coronary arteries has recently been described, but there has been no comparison with x-ray angiography of localisation or assessment of important characteristics of coronary stenosis. Methods-A breath hold, segmented kspace, 2D gradient echo imaging technique incorporating fat suppression was used in 39 patients (55 coronary stenoses) with known coronary artery disease. Results-Overall, 47 stenoses (85%) were assessed by magnetic resonance (29 of 33 stenoses in the left anterior descending artery, one of one in the left main stem, 14 of 17 in the right coronary artery, and three of four in the left circumflex artery were detected). There was close agreement between magnetic resonance and xray angiography for the distance of the stenosis from the arterial origin (magnetic resonance mean (SD) 27 (16) mm versus x-ray angiography 27 (16) mm, P = NS, mean difference -0-2 mm). The distance to 39 stenoses (83%) agreed to within 5 mm, with increased scatter for more distal stenoses. The severity of magnetic resonance signal loss, assessed visually at the site of stenosis, varied significantly according to the percentage diameter stenosis (F = 30, P < 0-0001); stenosis severity with severe signal loss was 89 (7)%, with partial signal was 70 (16)%, and with irregular wall only 37 (11)%, with significant differences among the three groups (P < 0.001). A significant correlation was found between the proportional magnetic resonance signal loss at the stenosis and the percentage diameter stenosis severity (r = -0-67, P < 0.0001). The length of stenosis measured by magnetic resonance (6 (3) mm) was greater than by x-ray angiography (5 (2) mm, P < 0-006, mean difference + 1 1 mm). Spearman's rank test showed that there was significant overestimation of stenosis length by magnetic resonance as stenosis severity increased (r. = 0 34, P < 0.02).Conclusions-Accurate localisation of coronary stenosis and a qualitative assessment of stenosis severity are possible by magnetic resonance, but stenosis length is overestimated as severity increases, probably because of disturbed patterns of flow with turbulence distal to severe stenoses. Reasonable results for the detection of coronary artery stenosis by magnetic resonance were achieved in this highly selected population, but further progress in imaging techniques is necessary before moving towards appreciable clinical application. (Heart 1996;75:127-133) Keywords: coronary artery stenosis; magnetic resonance angiography; x-ray angiography Imaging of the coronary arteries to localise stenosis, measure severity and assess the distal vessel is important in the management of coronary artery disease, and is essential before revascularisation by coronary bypass surgery or angioplasty. The invasive technique developed over the past 35 years, however, uses intra-arterial catheterisation an...

High‐resolution selective three‐dimensional magnetic resonance coronary angiography with navigator‐echo technique: Segment‐by‐segment evaluation of coronary artery stenosis

“…Although this study was preliminary, the overall sensitivity, specificity, and accuracy of hemodynamically significant stenosis were 80%, 85%, and 84%, respectively, which are comparable to those reported previously (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Magnetic resonance coronary angiography (MRCA) has been evaluated by many authors since the late 1980s (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Electrocardiography (ECG)-gated breath-hold and navigator-echo guided data acquisition have been evaluated to overcome image blurring due to cardiac and respiratory motion during the relatively long MR data acquisition process.…”

Magnetic Resonance Angiography

“…Most series have used the visual identification of a prominent signal "void" as being indicative of a diameter stenosis of Ͼ50%. Although the technique has been shown to accurately identify proximal and mid-coronary stenoses in some centers, [193][194][195] with good correlation with location of stenoses and with length of the coronary lesion slightly overestimated by MR, 194 data from other centers have been more variable (Table 6). 196 -199 Much of the variability in coronary MRA success is likely related to the lack of sequence standardization (data acquisition interval and TE) and the dependence on the breath-hold for respiratory artifact suppression.…”

Comparison of Diagnostic Performance of Multi Detector CT Angiography with Conventional Coronary Angiography for Assessment of Coronary Artery Disease

“…• Relatively thick areas (4-6 mm in many studies) may block a precise evaluating for central stenosis [85][86][87]. This likely additionally clarifies the restricted assessment of convoluted vessels and the distal segments of major coronary artery, particularly the left circumflex coronary artery [87][88][89].…”

“…This likely additionally clarifies the restricted assessment of convoluted vessels and the distal segments of major coronary artery, particularly the left circumflex coronary artery [87][88][89].…”