Tu-P9:374 Detection of coronary artery stenoses using breath-hold magnetic resonance coronary angiography. Comparison with conventional x-ray angiography

Background: CT coronary angiography is widely used to assess the presence of significant coronary artery disease (CAD). However, CT approach is associated with low but nonnegligible cancer risk. The purpose of this prospective multicenter study was to evaluate the diagnostic performance of coronary magnetic resonance angiography (MRA) in the ability to identify patients with significant CAD compared with coronary angiography. Materials and Methods: The subjects were recruited from 7 institutions. Free breathing coronary MR angiograms covering the entire coronary artery tree were obtained in 138 patients who were suspicious of CAD. Non-contrast enhanced images were acquired with a commercial 1.5T MR imager and five-element cardiac coils after sublingual administration of isosorbide dinitrate. Conventional X-ray coronary angiography was performed within 4 weeks after coronary MRA. MR and X-ray angiograms were sent to a core laboratory for blinded interpretation. Coronary MR angiograms were evaluated by two experienced investigators by using sliding partial MIP reconstruction. Quantitative X-ray coronary angiography analysis was performed with significant CAD defined as luminal narrowing of at least 50% of the diameter. Results: The mean imaging time of coronary MRA was 9.5 ± 4.9 minutes. The prevalence of significant disease on X-ray angiography was 45% (62/138). On a vessel-based analysis, the area under receiver operating characteristic (ROC) curve for the MRA compared with X-ray angiography was 0.90 (95% CI; 0.86 to 0.93). On a patient based analysis, the ROC area was 0.88 (95% CI; 0.81– 0.93). The sensitivity, specificity, positive and negative predictive values of coronary MRA by vessel analysis were 78% (95% CI; 68 – 86%), 86% (82–90%), 60% (51– 69%), 94% (90–96%). These values by patient analysis were 87% (95% CI; 76–94%), 71% (59 – 81%), 71% (59 – 81%), 87% (76–94%). Conclusions: In the current multicenter study using commercial 1.5T MR imagers and sliding partial MIP reconstruction, the diagnostic accuracy of coronary MRA compared to quantitative coronary angiography is good, reflected by an ROC area of 0.88 on patient-based analysis. High negative predictive value indicates that coronary MRA can be used for screening CAD.

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Magnetic resonance coronary angiography to evaluate coronary arterial lesions in patients with Kawasaki disease

Cardiology in the Young ◽

10.1017/s1047951106001168 ◽

2006 ◽

Vol 16 (6) ◽

pp. 563-571 ◽

Cited By ~ 31

Author(s):

Atsuko Suzuki ◽

Atsushi Takemura ◽

Rikako Inaba ◽

Tomoyoshi Sonobe ◽

Keiji Tsuchiya ◽

...

Keyword(s):

Magnetic Resonance ◽

Kawasaki Disease ◽

Coronary Angiography ◽

Black Blood ◽

X Ray ◽

Magnetic Resonance Coronary Angiography ◽

Arterial Lesions ◽

Black Blood Imaging ◽

Blood Imaging ◽

Bright Blood

We evaluated the efficiency of non-invasive magnetic resonance coronary angiography in detecting coronary arterial lesions in 106 patients, aged from 4 months to 37 years, with a median of 13 years, with Kawasaki disease. Non-contrast enhanced, free-breathing magnetic resonance coronary angiographic studies using both the steady-state free precession technique, namely bright blood imaging, and navigator-echo proton density weighted black blood imaging, so-called black blood imaging, were performed in all the patients. Conventional X-ray coronary angiography was performed in 70 patients with coronary arterial lesions.We observed 97 aneurysms, 17 dilatations, 17 occlusions, 18 localized stenoses and 10 recanalized vessels, and we clarified their unique pattern of images on magnetic resonance coronary angiography. The differences in size of the aneurysms as seen on X-ray coronary angiography and bright blood imaging was mean 0.0, and the 95% confidence interval was from −1.4 to 1.5 on the Bland-Altman plots. With bright blood imaging, the sensitivity of occlusion and localized stenosis based on X-ray angiography was 94.2% and 97.2%, specificity was 99.5% and 97.2%, and negative-predictive value was 99.5% and 97.2%, respectively. Black blood imaging provided remarkable visualization of the thickened intima of aneurysms, and/or thrombus, in 38 lesions. We conclude that magnetic resonance coronary angiography can visualize all types of lesions due to Kawasaki disease in patients of all ages, and that it is useful to reduce the number of times X-ray angiography needs to be performed in patients with Kawasaki disease.

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