Noninvasive detection of coronary artery stenosis using contrast-enhanced three-dimensional breath-hold magnetic resonance coronary angiography

OBJECTIVES The purpose of this study was to evaluate a contrast-enhanced th ree-dimensional (3D) breath-hold magnetic resonance (MR) technique for dete ction of coronary artery stenoses. BACKGROUND The accuracy of previously published MR coronary angiography pro tocols varies widely. Recently, coronary artery imaging using T1-shortening contrast agent has become possible, but so far there are no data concernin g its clinical application. METHODS Magnetic resonance coronary angiography was performed in 50 patient s with suspected coronary artery disease. Magnetic resonance data acquisiti on using an ultrafast 3D gradient-echo sequence lasted over 32 heartbeats w ithin one single breath-hold. Twenty milliliters of gadopentetate dimeglumi ne was injected at a flow rate of 1 ml/s for two successive studies coverin g the main coronary arteries in single-oblique planes. Stenosis assessment by MR was compared with significant (diameter stenosis > 50%) stenoses on X -ray angiography. Evaluation was limited to the proximal and mid-coronary a rtery segments. RESULTS Two hundred sixty-eight of 350 artery segments (76.6%) could be eva luated. Left circumflex coronary artery was only evaluable in 50%, of cases by MR. In the evaluable segments, 48 of 56 stenoses and 193 of 212 nonsten otic segments were correctly classified by MR. Oil a patient basis, MR corr ectly identified 34 of 36 patients with and 8 of 14 patients without signif icant coronary stenoses as demonstrated by X-ray angiography (sensitivity 9 4.4%, specificity 57.1%). CONCLUSION Oblique projection contrast-enhanced MR coronary angiograms obta ined within one single breath-hold permit identification of patients with c oronary stenoses in the proximal and mid segments of the major coronary art eries with satisfactory accuracy. (J Am Coll Cardiol 2000; 36: 13-50) (C) 2 000 by the American College of Cardiology.