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Coronary Artery Bypass Graft Patency: Assessment with True Fast Imaging with Steady-State Precession versus Gadolinium-enhanced MR Angiography¹

¹ From the Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney St, London SW3 6NP, England (N.H.B., A.S.J., R.H.M., D.J.P.); Siemens Medical Solutions, Erlangen, Germany (C.H.L.); and Minneapolis Heart Institute, Minneapolis, Minn (J.R.L.). Received November 29, 2001; revision requested February 13, 2002; final revision received August 30; accepted October 17. Supported by CORDA, the Heart Charity, and the Welcome Trust. Address correspondence to D.J.P. (e-mail: d.pennell@ic.ac.uk).

View larger version (99K): [in a new window]   Figure 1a. (a) Left: Coronal multisection true FISP angiographic image. Right: Transverse multisection true FISP angiographic image. (b) Left: Coronal MR angiographic slab includes the internal mammary vessels and heart. Right: Transverse MR angiographic slab.

View larger version (92K): [in a new window]   Figure 1b. (a) Left: Coronal multisection true FISP angiographic image. Right: Transverse multisection true FISP angiographic image. (b) Left: Coronal MR angiographic slab includes the internal mammary vessels and heart. Right: Transverse MR angiographic slab.

View larger version (58K): [in a new window]   Figure 2. Top: Transverse true FISP angiographic image. Bottom: Graphic representation of image. Patent grafts can be seen in their typical anatomic positions: 1 = venous graft to right coronary artery or posterior descending artery, 2 = right internal mammary artery without a graft, 3 = arterial graft from left internal mammary artery to left anterior descending artery, 4 = venous graft to left anterior descending artery or diagonal vessels, and 5 = venous graft to the circumflex artery or obtuse marginal vessels.

View larger version (45K): [in a new window]   Figure 3. Top: Three-dimensional volume-rendered image from a coronal MR angiographic data set. Bottom: Graphic representation of image. Patent grafts are seen in their typical anatomic positions: 1 = venous graft to right coronary artery or posterior descending artery, 2 = venous graft to left anterior descending coronary artery or diagonal vessels, and 3 = venous graft to the circumflex or obtuse marginal vessels. Internal mammary arteries are located more anteriorly and are not depicted.

View larger version (115K): [in a new window]   Figure 4. Left: Curved multiplanar reformation of an MR angiographic data set shows a patent left internal mammary graft (arrow). Right: Corresponding conventional angiogram confirms patency (arrow).

View larger version (99K): [in a new window]   Figure 5a. (a) Top: Transverse three-dimensional rendered MR angiographic image shows a patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery. Bottom: Coronal maximum intensity projection confirms patent graft (arrow). Distal insertion is not demonstrated. (b) Top: Transverse true FISP angiographic image shows corresponding patent saphenous Y graft (arrow). Bottom: Lower transverse true FISP angiographic image shows proximal segments of patent grafts (arrows). (c) Conventional angiogram confirms patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery.

View larger version (93K): [in a new window]   Figure 5b. (a) Top: Transverse three-dimensional rendered MR angiographic image shows a patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery. Bottom: Coronal maximum intensity projection confirms patent graft (arrow). Distal insertion is not demonstrated. (b) Top: Transverse true FISP angiographic image shows corresponding patent saphenous Y graft (arrow). Bottom: Lower transverse true FISP angiographic image shows proximal segments of patent grafts (arrows). (c) Conventional angiogram confirms patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery.

View larger version (173K): [in a new window]   Figure 5c. (a) Top: Transverse three-dimensional rendered MR angiographic image shows a patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery. Bottom: Coronal maximum intensity projection confirms patent graft (arrow). Distal insertion is not demonstrated. (b) Top: Transverse true FISP angiographic image shows corresponding patent saphenous Y graft (arrow). Bottom: Lower transverse true FISP angiographic image shows proximal segments of patent grafts (arrows). (c) Conventional angiogram confirms patent saphenous Y graft (arrow) to obtuse marginal vessels 1 and 2 of the circumflex artery.

View larger version (73K): [in a new window]   Figure 6a. (a) Three-dimensional reconstructions. Left: Surface rendering of MR angiographic data set demonstrates dilated patent venous graft (arrow). Right: Maximum intensity projection also shows the graft (arrow). (b) Three-dimensional rendering of true FISP multisection angiographic data set displays the origin, course, and insertion of the graft (arrow). (c) Conventional coronary angiogram confirms a dilated patent graft (arrow) to the left anterior descending artery.

View larger version (154K): [in a new window]   Figure 6b. (a) Three-dimensional reconstructions. Left: Surface rendering of MR angiographic data set demonstrates dilated patent venous graft (arrow). Right: Maximum intensity projection also shows the graft (arrow). (b) Three-dimensional rendering of true FISP multisection angiographic data set displays the origin, course, and insertion of the graft (arrow). (c) Conventional coronary angiogram confirms a dilated patent graft (arrow) to the left anterior descending artery.

View larger version (160K): [in a new window]   Figure 6c. (a) Three-dimensional reconstructions. Left: Surface rendering of MR angiographic data set demonstrates dilated patent venous graft (arrow). Right: Maximum intensity projection also shows the graft (arrow). (b) Three-dimensional rendering of true FISP multisection angiographic data set displays the origin, course, and insertion of the graft (arrow). (c) Conventional coronary angiogram confirms a dilated patent graft (arrow) to the left anterior descending artery.

View larger version (143K): [in a new window]   Figure 7a. (a) Three-dimensional reconstruction. Rendering of MR angiographic data set shows a patent graft (white arrow) to the posterior descending coronary artery and the native right coronary artery (black arrow). (b) Left: Conventional coronary angiogram shows a patent but diseased native right coronary artery (arrow). Right: Conventional coronary angiogram shows a patent graft (arrow) to the posterior descending coronary artery.

View larger version (80K): [in a new window]   Figure 7b. (a) Three-dimensional reconstruction. Rendering of MR angiographic data set shows a patent graft (white arrow) to the posterior descending coronary artery and the native right coronary artery (black arrow). (b) Left: Conventional coronary angiogram shows a patent but diseased native right coronary artery (arrow). Right: Conventional coronary angiogram shows a patent graft (arrow) to the posterior descending coronary artery.