Integrated cardiac magnetic resonance imaging with coronary magnetic resonance angiography, stress-perfusion, and delayed-enhancement imaging for the detection of occult coronary artery disease in asymptomatic individuals.
To evaluate the feasibility of using coronary magnetic resonance angiography (CMRA) with stress-perfusion and delayed-enhancement MRI as a screening tool for the detection of coronary artery disease (CAD) in asymptomatic subjects. Three hundred and forty-one self-referred asymptomatic subjects were enrolled in this study. Cardiac MR imaging was performed using a 1.5-T scanner with a 32-channel cardiac coil. Coronary artery stenosis, regional wall motion abnormalities, myocardial perfusion abnormalities, and delayed myocardial enhancement were analyzed. The occurrence of new chest pain and cardiac events was assessed in 332 subjects (97.3 %) over an average 29 ± 6 months (range, 18-39 months) follow-up period. A total of 3296 (82.4 %) of 4000 coronary artery segments examined exhibited diagnostic image quality on combined whole-heart and volume-targeted CMRA. Combined MRI detected significant CADs in 13 (3.8 %) of 341 subjects. Among these, 11 subjects (84.6 %) had both coronary artery stenosis (≥50 % by diameter) on CMRA and stress-perfusion defects in corresponding areas. Five of the 13 subjects showed evidence of old myocardial infarctions on delayed-enhancement MRI. Three subjects (0.9 %) underwent percutaneous coronary intervention after CAD was detected on cardiac MRI. There were no cardiac events during the follow-up period in subjects who complied with follow-up. Normal stress-perfusion and delayed-enhancement MRI lead to excellent outcomes when used to predict future cardiac events in asymptomatic subjects. Coronary MRA correlates well with stress-perfusion MRI for detecting significant CAD and helps exclude CAD in asymptomatic individuals.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-Gu, Seoul, 135-710, Republic of Korea.
Kyoung Doo
KD
Song
Sung Mok
SM
Kim
Yeon Hyeon
YH
Choe
Wooin
W
Jung
Sang-Chol
SC
Lee
Sung-A
SA
Chang
Yoon Ho
YH
Choi
Jidong
J
Sung
D000241:Adenosine / Q000008:administration & dosage*; D058070:Asymptomatic Diseases; D003287:Contrast Media / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000503:physiopathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007262:Infusions, Intravenous; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009942:Organometallic Compounds / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage*
D003287:Contrast Media; D009942:Organometallic Compounds; D014665:Vasodilator Agents; C090600:gadobutrol; D000241:Adenosine