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Coronary Artery Imaging with Real-time Navigator Three-dimensional Turbo-Field-Echo MR Coronary Angiography: Initial Experience¹

¹ From the Departments of Radiology (J.B., S.D., R.B.) and Cardiology (J.P., F.E.R.), Gasthuisberg University Hospital, Leuven, Belgium; and Department of Radiology, Mayo Clinic, Jacksonville, Fla (R.K.). Received October 29, 2001; revision requested December 10; final revision received July 17, 2002; accepted August 13. Address correspondence to J.B., Department of Radiology, University Hospitals, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium (e-mail: jan.bogaert@uz.kuleuven.ac.be).

View larger version (149K): [in a new window]   Figure 1. Coronal localizer MR angiogram (11/2.4) shows positioning of the navigator beam through the dome of the right hemidiaphragm. The area outlined by the stacked squares represents the positioning of the navigator on the dome of the right hemidiaphragm.

View larger version (15K): [in a new window]   Figure 2. Timing and order of sequence elements used to obtain the scout image and submillimeter MR coronary angiograms. ECG = electrocardiography, FAT-SAT = fat saturation sequence, MRA = MR angiography, R = R wave, TFE-EPI = TFE echo-planar imaging.

View larger version (188K): [in a new window]   Figure 3a. (a) Transverse 3D TFE MR coronary angiograms (most caudal [top row, far left image] to most cranial [bottom row, far right image]) (7.1/1.97, 30° flip angle) with excellent image quality (score 5) obtained in a 56-year-old man referred for coronary catheterization. Both readers interpreted these images of the left coronary tree as normal. (b) Conventional coronary angiogram findings in the same patient confirmed the normal left coronary artery system.

View larger version (138K): [in a new window]   Figure 3b. (a) Transverse 3D TFE MR coronary angiograms (most caudal [top row, far left image] to most cranial [bottom row, far right image]) (7.1/1.97, 30° flip angle) with excellent image quality (score 5) obtained in a 56-year-old man referred for coronary catheterization. Both readers interpreted these images of the left coronary tree as normal. (b) Conventional coronary angiogram findings in the same patient confirmed the normal left coronary artery system.

View larger version (152K): [in a new window]   Figure 4a. Hemodynamically significant stenosis of RCA2 in a 61-year-old man. (a) Both readers correctly identified the stenosis (arrow) depicted on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle). (b) Conventional coronary angiogram findings confirmed the stenosis (arrow).

View larger version (149K): [in a new window]   Figure 4b. Hemodynamically significant stenosis of RCA2 in a 61-year-old man. (a) Both readers correctly identified the stenosis (arrow) depicted on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle). (b) Conventional coronary angiogram findings confirmed the stenosis (arrow).

View larger version (188K): [in a new window]   Figure 5a. Hemodynamically significant stenosis of LAD1 in a 64-year-old man. (a) Both readers correctly identified the stenosis (arrow) on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle). (b) Conventional coronary angiogram findings confirmed the stenosis (arrow).

View larger version (153K): [in a new window]   Figure 5b. Hemodynamically significant stenosis of LAD1 in a 64-year-old man. (a) Both readers correctly identified the stenosis (arrow) on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle). (b) Conventional coronary angiogram findings confirmed the stenosis (arrow).

View larger version (173K): [in a new window]   Figure 6a. Proximal occlusion of the RCA in a 63-year-old man. (a) Both readers judged the RCA depicted on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle) to be normal. (b) Conventional coronary angiogram obtained a few hours after a shows proximal RCA occlusion (arrow) with retrograde filling of the RCA by collateral vessels (arrowheads).

View larger version (174K): [in a new window]   Figure 6b. Proximal occlusion of the RCA in a 63-year-old man. (a) Both readers judged the RCA depicted on the 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle) to be normal. (b) Conventional coronary angiogram obtained a few hours after a shows proximal RCA occlusion (arrow) with retrograde filling of the RCA by collateral vessels (arrowheads).

View larger version (192K): [in a new window]   Figure 7a. (a) 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle) obtained in a 54-year-old man depicts a coronary artery stent in LAD2 as an area of signal void. The LCX1 is thin and was incorrectly judged by reader 1 to be stenotic. (b) Conventional coronary angiogram obtained in the same patient shows the LCX to be normal.

View larger version (141K): [in a new window]   Figure 7b. (a) 3D TFE MR coronary angiogram (7.1/1.97, 30° flip angle) obtained in a 54-year-old man depicts a coronary artery stent in LAD2 as an area of signal void. The LCX1 is thin and was incorrectly judged by reader 1 to be stenotic. (b) Conventional coronary angiogram obtained in the same patient shows the LCX to be normal.

View larger version (28K): [in a new window]   Figure 8. ROC curves for detection of hemodynamically significant coronary artery stenoses at MR coronary angiography. = reader 1, = reader 2. Straight line represents the line of chance.