title: Coronary vessel wall contrast enhancement imaging as a potential direct marker of coronary involvement: integration of findings from CAD and SLE patients.
abstract: OBJECTIVE
  This study investigated the feasibility of visual and quantitative assessment of coronary vessel wall contrast enhancement (CE) for detection of symptomatic atherosclerotic coronary artery disease (CAD) and subclinical coronary vasculitis in autoimmune inflammatory disease (systemic lupus erythematosus [SLE]), as well as the association with aortic stiffness, an established marker of risk.
  
  
  BACKGROUND
  Coronary CE by cardiac magnetic resonance (CMR) is a novel noninvasive approach to visualize gadolinium contrast uptake within the coronary artery vessel wall.
  
  
  METHODS
  A total of 75 subjects (CAD: n = 25; SLE: n = 27; control: n = 23) underwent CMR imaging using a 3-T clinical scanner. Coronary arteries were visualized by a T2-prepared steady state free precession technique. Coronary wall CE was visualized using inversion-recovery T1 weighted gradient echo sequence 40 min after administration of 0.2 mmol/kg gadobutrol. Proximal coronary segments were visually examined for distribution of CE and quantified for contrast-to-noise ratio (CNR) and total CE area.
  
  
  RESULTS
  Coronary CE was prevalent in patients (93%, n = 42) with a diffuse pattern for SLE and a patchy/regional distribution in CAD patients. Compared with control subjects, CNR values and total CE area in patients with CAD and SLE were significantly higher (mean CNR: 3.9 ± 2.5 vs. 6.9 ± 2.5 vs. 6.8 ± 2.0, respectively; p < 0.001; total CE area: median 0.8 [interquartile range (IQR): 0.6 to 1.2] vs. 3.2 [IQR: 2.6 to 4.0] vs. 3.3 [IQR: 1.9 to 4.5], respectively; p < 0.001). Both measures were positively associated with aortic stiffness (CNR: r = 0.61, p < 0.01; total CE area: 0.36, p = 0.03), hypercholesterolemia (r = 0.68, p < 0.001; r = 0.61, p < 0.001) and hypertension (r = 0.40, p < 0.01; r = 0.32, p < 0.05).
  
  
  CONCLUSIONS
  We demonstrate that quantification of coronary CE by CNR and total CE area is feasible for detection of subclinical and clinical uptake of gadolinium within the coronary vessel wall. Coronary vessel wall CE may become an instrumental novel direct marker of vessel wall injury and remodeling in subpopulations at risk.
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Niharika
authors: N
authors: Varma
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Rocio
authors: R
authors: Hinojar
authors: The Lupus Unit, Rayne's Institute, King's College London, London, United Kingdom.
authors: David
authors: D
authors: D'Cruz
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Eduardo
authors: E
authors: Arroyo Ucar
authors: Department of Medical Physics and Bioengineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Andreas
authors: A
authors: Indermuehle
authors: Department of Medical Physics and Bioengineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Sarah
authors: S
authors: Peel
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Gerald
authors: G
authors: Greil
authors: Department of Medical Physics and Bioengineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Nicholas
authors: N
authors: Gaddum
authors: Cardiovascular Division, King's College London, London, United Kingdom.
authors: Phil
authors: P
authors: Chowienczyk
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Eike
authors: E
authors: Nagel
authors: Department of Medical Physics and Bioengineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
authors: Rene M
authors: RM
authors: Botnar
authors: Cardiovascular Imaging Department, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom. Electronic address: v.puntmann@kcl.ac.uk.
authors: Valentina O
authors: VO
authors: Puntmann
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D016022:Case-Control Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia; D007090:Image Interpretation, Computer-Assisted; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D066253:Vascular Remodeling; D059289:Vascular Stiffness; D014657:Vasculitis / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: cardiac magnetic resonance; contrast-to-noise ratio; coronary enhancement; vessel wall remodeling