Clinical Application of Non‐Contrast‐Enhanced Dixon Water‐Fat Separation Compressed SENSE Whole‐Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin

Abstract

Background3.0 T non‐contrast‐enhanced nitroglycerin (NTG)‐assisted whole‐heart coronary magnetic resonance angiography (MRA) employing Dixon water‐fat separation and compressed SENSE (CS‐SENSE) acceleration is a promising method for diagnosing coronary artery disease (CAD).PurposeTo evaluate the diagnostic performance of this technique for detecting clinically‐relevant (≥50% diameter reducing) CAD and to evaluate the difference in NTG‐induced coronary vasodilation between patients with and without clinically‐relevant CAD.Study TypeProspective.PopulationSixty‐six patients with suspected CAD.Field Strength/Sequence3.0 T; CSSENSE, Dixon water‐fat separation, three‐dimensional segmented turbo field gradient‐echo sequence for whole‐heart coronary MRA.AssessmentOverall image quality of coronary MRA was calculated on the basis of all visible coronary segments. The diagnostic performance of coronary MRA for detecting a ≥50% reduction in coronary artery diameter with and without NTG was compared using X‐ray coronary angiography (CAG) as the reference. According to CAG, patients were divided into a non‐clinically‐relevant CAD group and clinically‐relevant CAD group, and the difference in NTG‐induced vasodilation between the groups was evaluated.Statistical TestsUnpaired/paired Student's t‐test, Mann–Whitney U test, paired Wilcoxon signed‐rank test, χ2 test, McNemar test. A two‐tailed P value <0.05 was considered significant.ResultsOverall image quality was increased significantly in the coronary MRA images after NTG. The diagnostic performance of the non‐NTG vs. NTG‐assisted coronary MRA was as follows on a per‐patient basis: sensitivity 94.3% vs. 94.3%, specificity 64.5% vs. 83.9%, positive predictive value 75.0% vs. 86.8%, negative predictive value 90.9% vs. 92.9%, and accuracy 80.3% vs. 89.4%, respectively. NTG‐induced vasodilation was significantly lower in the clinically‐relevant CAD group than in the non‐clinically‐relevant CAD group (13.7 ± 8.1% vs. 24.1 ± 16.3%).Data ConclusionNon‐contrast Dixon water‐fat separation CS‐SENSE coronary MRA at 3.0 T can noninvasively detect clinically‐relevant CAD and sublingual NTG improved performance. Combining pre‐ and post‐NTG coronary MRA may provide a simple noninvasive and nonionizing test to evaluate coronary vasodilation function.Level of Evidence1Technical Efficacy Stage2

A clinical strategy to improve the diagnostic performance of 3T non-contrast coronary MRA and noninvasively evaluate coronary distensibility: combination of diastole and systole imaging

“…A previous study has found that the Dixon water-fat method provides improved non-contrast coronary MRA image quality at 3T compared to the conventional spectral inversion recovery (SPIR) technique [32]. In a study from 2022, Lu et al have demonstrated the feasibility of 3T non-contrast water-fat separated coronary MRA for detect clinically significant coronary stenosis [34]. There are two relatively quiescent periods in the cardiac cycle for acquiring images, mid-diastole and end-systole, lasting for an average of 187 ms and 118 ms [6] respectively.…”

The feasibility of relaxation-enhanced angiography without contrast and triggering for preprocedural planning of transcatheter aortic valve implantation

“…A free-breathing, non-contrast, Dixon water-fat separation 3D whole-heart MRI sequence was applied ( 21 ), with the following settings: time to echo (TE), 1.54 ms; repetition time (TR), 3.5 ms; flip angle, 10 ° ; compressed sensing (CS) factor, 2.5; k-space Cartesian; matrix, 256 × 184 × 250 mm; mDIXON, ECG-gated; the trigger delay, 240–300 ms of the temporal window. This acquisition window was determined by a four-chamber view of the left ventricle with reduced motion and a turbo field echo (TFE) shot duration of 80–130 ms, depending on the heart rate.…”

Editorial for “Clinical Application of Non‐Contrast‐Enhanced Dixon Water‐Fat Separation Compressed SENSE Whole‐Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin”

“…In Lu et al, 8 the authors used a 3 T noncontrast‐enhanced Dixon water‐fat separation coronary MR angiography with CS reconstruction techniques to detect significant CAD and evaluate the difference in the effect of sublingual nitroglycerin on coronary vasodilation between the significant CAD and the nonsignificant CAD groups. They also demonstrated that sublingual nitroglycerin enhanced the visibility of the coronary arteries, thereby improving the diagnostic performance of the proposed method.…”