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MR Coronary Angiography with Breath-hold Targeted Volumes: Preliminary Clinical Results¹

¹ From the Departments of Cardiology, Thoraxcenter (R.J.M.v.G., B.J.W.M.R., M.H., P.J.d.F.) and Radiology, Daniel den Hoed Kliniek (P.A.W., H.G.d.B., P.M.A.v.O., M.O.), University Hospital Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, the Netherlands. From the 1998 RSNA Scientific Assembly. Received July 28, 1999; revision requested September 1; revision received February 17, 2000; accepted April 4. Address correspondence to R.J.M.v.G. (e-mail: vangeuns@card.azr.nl).

View larger version (54K): [in a new window]   Figure 1. Drawing illustrates breath-hold 3D imaging of the coronary arteries with VCATS protocol. Different volumes are targeted for a detailed examination of selected coronary arterial segments. The major coronary segments can be imaged during seven breath holds. Four examples of possible angulations (rectangles) are illustrated. dist = distal, LAD = left anterior descending coronary artery, LM = left main coronary artery, mid = middle, prox = proximal, RCA = right coronary artery.

View larger version (72K): [in a new window]   Figure 2a. In a and b, Ao = aorta, PA = pulmonary artery. (a) Double-oblique, 3D, breath-hold, segmented, gradient-echo MR images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the middle segment of the right coronary artery in a 43-year-old man. Three consecutive sections show the continuation of a nondiseased tortuous vessel (arrows) through the volume. LV = left ventricle, RV = right ventricle. (b) Transverse targeted-volume images of the left main (LM) and proximal left anterior descending (LAD) arteries in a 45-year-old woman.

View larger version (68K): [in a new window]   Figure 2b. In a and b, Ao = aorta, PA = pulmonary artery. (a) Double-oblique, 3D, breath-hold, segmented, gradient-echo MR images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the middle segment of the right coronary artery in a 43-year-old man. Three consecutive sections show the continuation of a nondiseased tortuous vessel (arrows) through the volume. LV = left ventricle, RV = right ventricle. (b) Transverse targeted-volume images of the left main (LM) and proximal left anterior descending (LAD) arteries in a 45-year-old woman.

View larger version (64K): [in a new window]   Figure 3a. (a) Double-oblique 3D breath-hold segmented gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the right coronary artery (solid arrows) in a 72-year-old man. Three consecutive sections demonstrate the presence of hemodynamically significant stenoses (open arrows) followed by complete occlusion. Ao = aorta, RV = right ventricle. (b) Corresponding conventional coronary angiogram shows the stenoses (arrows).

View larger version (145K): [in a new window]   Figure 3b. (a) Double-oblique 3D breath-hold segmented gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the right coronary artery (solid arrows) in a 72-year-old man. Three consecutive sections demonstrate the presence of hemodynamically significant stenoses (open arrows) followed by complete occlusion. Ao = aorta, RV = right ventricle. (b) Corresponding conventional coronary angiogram shows the stenoses (arrows).

View larger version (75K): [in a new window]   Figure 4a. (a) Transverse, 3D, segmented, gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of stenosis (open arrows) of a proximal left anterior descending coronary artery (LAD) in a 51-year-old man. Ao = aorta, GCV = great cardiac vein, LM = left main coronary artery, PA = pulmonary artery. (b) Corresponding conventional coronary angiogram shows the stenosis (arrow).

View larger version (133K): [in a new window]   Figure 4b. (a) Transverse, 3D, segmented, gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of stenosis (open arrows) of a proximal left anterior descending coronary artery (LAD) in a 51-year-old man. Ao = aorta, GCV = great cardiac vein, LM = left main coronary artery, PA = pulmonary artery. (b) Corresponding conventional coronary angiogram shows the stenosis (arrow).

View larger version (164K): [in a new window]   Figure 5a. False-negative findings of stenosis. (a) Double-oblique, 3D, breath-hold, segmented, gradient-echo image (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the right coronary artery in a 44-year-old woman. The clearly delineated vessel (arrows) seems to be patent for at least 5 cm. Ao = aorta, LV = left ventricle, PA = pulmonary artery, RV = right ventricle. (b) Corresponding conventional coronary angiogram shows the vessel in a (open and solid arrows) with an occluded middle segment (open arrow).

View larger version (183K): [in a new window]   Figure 5b. False-negative findings of stenosis. (a) Double-oblique, 3D, breath-hold, segmented, gradient-echo image (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the right coronary artery in a 44-year-old woman. The clearly delineated vessel (arrows) seems to be patent for at least 5 cm. Ao = aorta, LV = left ventricle, PA = pulmonary artery, RV = right ventricle. (b) Corresponding conventional coronary angiogram shows the vessel in a (open and solid arrows) with an occluded middle segment (open arrow).

View larger version (52K): [in a new window]   Figure 6a. False-positive findings of stenosis. (a) Transverse, 3D, segmented, gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) through the proximal right coronary artery in a 71-year-old man. On four consecutive sections, the right coronary artery seems to be occluded (open arrow) beyond 0.5 cm of its origin (solid arrows) owing to incomplete fat suppression and partial Fourier reconstruction. Ao = aorta, LA = left atrium, LV = left ventricle, PA = pulmonary artery. (b) Corresponding conventional coronary angiogram shows the vessel to be patent.

View larger version (192K): [in a new window]   Figure 6b. False-positive findings of stenosis. (a) Transverse, 3D, segmented, gradient-echo images (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) through the proximal right coronary artery in a 71-year-old man. On four consecutive sections, the right coronary artery seems to be occluded (open arrow) beyond 0.5 cm of its origin (solid arrows) owing to incomplete fat suppression and partial Fourier reconstruction. Ao = aorta, LA = left atrium, LV = left ventricle, PA = pulmonary artery. (b) Corresponding conventional coronary angiogram shows the vessel to be patent.

View larger version (129K): [in a new window]   Figure 7a. (a) Right anterior, volume-rendered, double-oblique, 3D, breath-hold, segmented, gradient-echo image (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of a targeted volume of a nondiseased right coronary artery (arrows) in a 43-year-old man. Ao = aorta, RA = right atrium, RV = right ventricle. (b) Anterior cranial volume-rendered image of a targeted volume of the aortic root in the same patient. Ao = aorta, LAD = left anterior descending coronary artery, LCX = left circumflex coronary artery, RCA = right coronary artery, RVOT = right ventricular outflow tract.

View larger version (148K): [in a new window]   Figure 7b. (a) Right anterior, volume-rendered, double-oblique, 3D, breath-hold, segmented, gradient-echo image (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of a targeted volume of a nondiseased right coronary artery (arrows) in a 43-year-old man. Ao = aorta, RA = right atrium, RV = right ventricle. (b) Anterior cranial volume-rendered image of a targeted volume of the aortic root in the same patient. Ao = aorta, LAD = left anterior descending coronary artery, LCX = left circumflex coronary artery, RCA = right coronary artery, RVOT = right ventricular outflow tract.

View larger version (165K): [in a new window]   Figure 8. Right anterior, volume-rendered, double-oblique, 3D, breath-hold, segmented, gradient-echo image (TurboFLASH, 5.3/2.3, incremental flip angle, 21 lines per segment, 110-msec acquisition window, 1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) (right) and corresponding conventional coronary angiogram (left) of a targeted volume of a right coronary artery in a 57-year-old man show two hemodynamically significant stenoses (arrows). RA = right atrium, RV = right ventricle.

View larger version (151K): [in a new window]   Figure 9. Anterior volume-rendered image (1.9 x 1.25 x 1.5-mm resolution with interpolation by zero filling) of the right coronary artery in the patient in Figure 3 with hemodynamically significant stenoses (arrows) followed by complete occlusion. Ao = aorta, RV = right ventricle.