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Contrast-enhanced MR Imaging for Evaluation of Coronary Artery Disease before Elective Repair of Aortic Aneurysm¹

¹ From the Departments of Radiology (M.I., H.S., N.K., N.I., K.K., K.T.) and Thoracic and Cardiovascular Surgery (T.S., I.Y.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. From the 2003 RSNA Annual Meeting. Received June 1, 2004; revision requested August 19; revision received November 8; accepted December 4. Address correspondence to H.S. (e-mail: sakuma{at}clin.medic.mie-u.ac.jp).

PURPOSE: To prospectively evaluate the accuracy of first-pass contrast material–enhanced magnetic resonance (MR) imaging during stress and delayed contrast-enhanced MR imaging in the detection of significant coronary artery disease in patients before elective repair of aortic aneurysm.

MATERIALS AND METHODS: The study was approved by the institutional ethics committee, and informed consent was obtained from all patients. MR imaging was performed in 49 patients (42 men and seven women; mean age, 72.2 years; age range, 58–85 years) before the elective repair of atherosclerotic aortic aneurysms. Thirty-two patients had an abdominal aneurysm, 12 had a thoracic aneurysm, and five had a thoracoabdominal aneurysm. First-pass contrast-enhanced MR images were obtained with short-axis sections encompassing the entire left ventricular myocardium in the resting state and during pharmacologic stress. Inversion-recovery-prepared delayed contrast-enhanced MR images were obtained with breath holding to evaluate for the presence of infarction. All patients underwent coronary angiography within 2 weeks of MR imaging, and these findings were used as the standard of reference. The diagnostic results of first-pass contrast-enhanced MR imaging, delayed contrast-enhanced MR imaging, and a combination of both MR imaging methods in the detection of significant coronary artery disease were expressed as sensitivity, specificity, and accuracy.

RESULTS: Coronary angiography depicted a clinically significant stenosis (>70% luminal diameter narrowing) in the coronary artery in 34 of the 49 patients (69%). First-pass contrast-enhanced MR imaging depicted stress-induced hypoenhancement in 27 of those 34 patients (79%). Delayed myocardial enhancement was observed in 17 of the 34 patients (50%). The overall sensitivity of rest-stress first-pass contrast-enhanced MR imaging and delayed contrast-enhanced MR imaging combined in the prediction of at least one coronary artery with significant stenosis was 88% (30 of 34 patients). The specificity and accuracy of MR imaging were 87% (13 of 15 patients) and 88% (43 of 49 patients), respectively.

CONCLUSION: Contrast-enhanced MR imaging had an accuracy of 88% in the detection of significant coronary artery disease in patients with aortic aneurysm.

© RSNA, 2005

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