Magnetic resonance coronary angiography: where are we today?

Abstract

Although cardiovascular magnetic resonance allows the non-invasive and radiation free visualization of both the coronary arteries and veins, coronary vessel wall imaging is still undergoing technical development to improve diagnostic quality. Assessment of the coronary vessels is a valuable addition to the analysis of cardiac function, cardiac anatomy, viability and perfusion which magnetic resonance imaging reliably allows. However, cardiac and respiratory motion and the small size of the coronary vessels present a challenge and require several technical solutions for image optimization. Furthermore, the acquisition protocols need to be adapted to the specific clinical question. This review provides an update on the current clinical applications of cardiovascular magnetic resonance coronary angiography, recent technical advances and describes the acquisition protocols in use.

Fig. 1

(A) Sequence diagram of the 2D navigator (2Dnav) used for prospective motion correction (Adapted from Henningsson et al. [88]). The 2Dnav is acquired from the startup profiles of the sequence and uses fat suppression (spectrally selective inversion recovery, FAT SUP) and fold-over suppression to suppress signal from epicardial fat and to reduce fold-over artifacts. Reconstruction and image registration are performed immediately after 2Dnav acquisition, which yields displacement information in FH and LR direction and is used for slice tracking. The 2Dnav can be combined with 2D or 3D gradient echo-based imaging sequences. The trailing 1D navigator is used for respiratory gating. The scanner gradients in measurement (M), phase encoding (P), and slice selection (S) are shown for the sequence, along with the radiofrequency pulses. (B,C,D,E) Examples of right and left coronary artery visualized with the 2Dnav sequence