Respiratory self-navigated postcontrast whole-heart coronary MR angiography: initial experience in patients.
OBJECTIVE
To assess the diagnostic performance of respiratory self-navigation for whole-heart coronary magnetic resonance (MR) angiography in a patient cohort referred for diagnostic cardiac MR imaging.


METHODS
Written informed consent was obtained from all participants for this institutional review board-approved study. Self-navigated coronary MR angiography was performed after administration of a contrast agent in 78 patients (mean age, 48.5 years ± 20.7 [standard deviation]; 53 male patients) referred for cardiac MR imaging because of coronary artery disease (n = 40), cardiomyopathy (n = 14), congenital anomaly (n = 17), or "other" (n = 7). Examination duration was recorded, and the image quality for each coronary segment was assessed with consensus reading. Vessel sharpness, length, and diameter were measured. Quantitative values in proximal, middle, and distal segments were compared by using analysis of variance and t tests. A double-blinded comparison with the results of x-ray angiography was performed when such results were available.


RESULTS
When patients with different indications for cardiac MR imaging were examined with self-navigated postcontrast coronary MR angiography, whole-heart data sets with 1.15-mm isotropic spatial resolution were acquired in an average of 7.38 minutes ± 1.85. The main and proximal coronary segments could be visualized in 92.3% of cases, while the middle and distal segments could be visualized in 84.0% and 55.8% of cases, respectively. Subjective scores and vessel sharpness were significantly higher in the proximal segments than in the middle and distal segments (P < .05). Anomalies of the coronary arteries could be confirmed or excluded in all cases. Per-vessel sensitivity and specificity for stenosis detection were 64.7% and 85.0%, respectively, in the 31 patients for whom reference standard x-ray coronary angiography results were available.


CONCLUSIONS
The self-navigated coronary MR angiography sequence shows promise for coronary imaging. However, technical improvements are needed to improve image quality, especially in the more distal coronary segments.
From Advanced Clinical Imaging Technology, Siemens Healthcare IM BM PI, Lausanne, Switzerland (D.P.); Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland (D.P., S.C., G.B., R.B.v.H., J.C., M.S.); Center for Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., S.C., G.B., R.B.v.H., J.C., M.S.); Pattern Recognition Laboratory, Department of Computer Science, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany (D.P.); Division of Cardiology and Cardiac MR Center, University Hospital of Lausanne, Lausanne, Switzerland (P.M., C.S., G.V., J.d.B., S.C.K., T.R., J.S.); and MR Research and Development (A.L.), MR Product Innovation and Definition (M.O.Z.), Healthcare Sector, Siemens, Erlangen, Germany.
Davide
D
Piccini
Pierre
P
Monney
Christophe
C
Sierro
Simone
S
Coppo
Gabriele
G
Bonanno
Ruud B
RB
van Heeswijk
Jérôme
J
Chaptinel
Gabriella
G
Vincenti
Jonathan
J
de Blois
Simon C
SC
Koestner
Tobias
T
Rutz
Arne
A
Littmann
Michael O
MO
Zenge
Juerg
J
Schwitter
Matthias
M
Stuber
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003287:Contrast Media; D017023:Coronary Angiography; D004311:Double-Blind Method; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012119:Respiration
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol