Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries

Abstract

Cardiovascular magnetic resonance (CMR) allows the nonradiating assessment of coronary arteries; to achieve better image quality cardiorespiratory artefacts should be corrected. Coronary MRA (CMRA) at the moment is indicated only for the detection of abnormal coronary origin, coronary artery ectasia and/or aneurysms (class I indication) and coronary bypass grafts (class II indication). CMRA utilisation for coronary artery disease is not yet part of clinical routine. However, the lack of radiation is of special value for the coronary artery evaluation in children and women. CMRA can assess the proximal part of coronary arteries in almost all cases. The best results have been observed in the evaluation of the left anterior descending and the right coronary artery, while the left circumflex, which is located far away from the coil elements, is frequently imaged with reduced quality, compared to the other two. Different studies detected an increase in wall thickness of the coronaries in patients with type I diabetes and abnormal renal function. Additionally, the non-contrast enhanced T1-weighed images detected the presence of thrombus in acute myocardial infarction. New techniques using delayed gadolinium enhanced imaging promise the direct visualization of inflamed plaques in the coronary arteries. The major advantage of CMR is the potential of an integrated protocol offering assessment of coronary artery anatomy, cardiac function, inflammation and stress perfusion-fibrosis in the same study, providing an individualized clinical profile of patients with heart disease.

Keywords: Coronary angiography; Coronary venous system; Gadolinium; Magnetic resonance imaging

Core tip: Cardiovascular magnetic resonance (CMR) allows the non-radiating assessment of coronary arteries. At the moment it is indicated only to detection of abnormal coronary artery origin, ectasia and/or aneurysms (class I indication) and coronary artery bypass grafts (class II indication). The utilisation of coronary MRA (CMRA) for coronary artery disease diagnosis is not at the moment part of clinical routine. However, due to lack of radiation is particularly useful for children and women. A combined CMR protocol, including CMRA and stress perfusion-fibrosis evaluation may offer a non-invasive assessment of cardiovascular profile in high risk patients.