[Clinical value of magnetic resonance tomography in imaging coronary stenoses. A comparison with coronary angiography and myocardial scintigraphy].
OBJECTIVE
The development of ultra-rapid gradient-echo sequence magnetic resonance imaging (MRI) makes it possible to visualize coronary arteries. But the clinical value of coronary artery MRI (MRCA) still needs to be established. It was the aim of this study to determine whether MRCA can demonstrate proximal parts of the coronary arteries and visualize haemodynamically relevant stenoses.


METHODS
MRCA was performed, using segmented 2D sequences and a navigator pulse, in 29 patients (22 men, seven women, mean age 60 +/- 10 years) in whom coronary heart disease (CHD) was suspected or who, with proven CHD (> or = 50% stenosis) further treatment was to be established. Exercise myocardial scintigraphy with single proton emission tomography (SPECT) was additionally performed in 20 of the patients.


RESULTS
Seven of 87 coronary arteries (8%) could not be demonstrated because the patients' claustrophobia necessitated premature termination of the investigation: these vessels were excluded from the final analysis. The mean length of the visualized coronary arteries was 12 +/- 4 mm for the main stem (LM), 36 +/- 14 mm for the left interventricular branch (LAD), 18 +/- 12 mm for the circumflex branch (CX) and 67 +/- 23 mm for the right coronary artery (RCA). Of 37 stenoses demonstrated by coronary angiography 29 were also visualized by MRCA: 13 of 18 LAD stenoses, two of three CX stenoses and 14 of 16 RCA stenoses. Mean sensitivity of MRCA was 78%, mean specificity 86%. In patients who had undergone exercise SPECT, coronary angiography demonstrated 26 stenoses, of which 16 (six LAD, two CX and eight RCA stenoses) were haemodynamically significant. Of these 16 stenoses MRCA demonstrated 13, but three stenoses (one RCA and two LAD stenoses) were not visualized, because the stenoses were distal to the demonstrated segments.


CONCLUSIONS
MRCA can visualize moderately severe stenoses, especially of the proximal coronary arterial segments. This method represents an new approach to noninvasive diagnosis of CHD, but additional technical improvements will have to be made.
Schmidt
M
M
Klinik und Poliklinik für Nuklearmedizin, Universität Köln.
Theissen
P
P
Crnac
J
J
Jochims
M
M
Voth
E
E
Baer
F M
FM
Schicha
H
H
Erdmann
E
E
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000295:instrumentation*; D003327:Coronary Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology; D017352:Echo-Planar Imaging / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*
Klinischer Nutzen der Magnetresonanztomographie zur Darstellung von Koronarstenosen. Ein Vergleich mit der Koronarangiographie und der Myokardszintigraphie.