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Review
. 2017 Feb 26;9(2):92-108.
doi: 10.4330/wjc.v9.i2.92.

Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

James R J Foley  1 , Sven Plein  1 , John P Greenwood  1
Affiliations
Review

Assessment of stable coronary artery disease by cardiovascular magnetic resonance imaging: Current and emerging techniques

James R J Foley et al. World J Cardiol. .

Abstract

Coronary artery disease (CAD) is a leading cause of death and disability worldwide. Cardiovascular magnetic resonance (CMR) is established in clinical practice guidelines with a growing evidence base supporting its use to aid the diagnosis and management of patients with suspected or established CAD. CMR is a multi-parametric imaging modality that yields high spatial resolution images that can be acquired in any plane for the assessment of global and regional cardiac function, myocardial perfusion and viability, tissue characterisation and coronary artery anatomy, all within a single study protocol and without exposure to ionising radiation. Advances in technology and acquisition techniques continue to progress the utility of CMR across a wide spectrum of cardiovascular disease, and the publication of large scale clinical trials continues to strengthen the role of CMR in daily cardiology practice. This article aims to review current practice and explore the future directions of multi-parametric CMR imaging in the investigation of stable CAD.

Keywords: Cardiovascular magnetic resonance; Coronary heart disease; Myocardial perfusion; Prognosis; Viability.

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Conflict of interest statement

Conflict-of-interest statement: No conflicts of interest.

Figures

Figure 1
Figure 1
Cardiovascular magnetic resonance imaging techniques. A and B show short axis and 4 chamber cine images respectively for anatomical and functional assessment; C shows stress perfusion with a septal perfusion defect (arrow); D shows early gadolinium enhancement imaging with a large apical thrombus (arrow); E is late gadolinium enhanced imaging with a transmural inferior infarction (arrows); F is 3D whole heart magnetic resonance angiography. LGE: Late gadolinium enhancement; EGE: Early gadolinium enhancement.
Figure 2
Figure 2
Cardiovascular magnetic resonance multi-parametric protocols for the investigation of suspected coronary artery disease. A shows a typical multi-parametric cardiovascular magnetic resonance protocol for the investigation of stable coronary artery disease with adenosine stress perfusion; and B with incremental dose dobutamine stress.
Figure 3
Figure 3
Cardiovascular magnetic resonance perfusion techniques. A is a high spatial resolution k-t BLAST stress perfusion CMR study at 3.0T showing an antero-septal perfusion defect with corresponding left anterior descending lesion at angiography in B; C shows a transmural lateral perfusion defect at standard resolution at 1.5T with corresponding circumflex lesion in D; E shows a transmural inferior perfusion defect at standard resolution at 1.5T with corresponding right coronary artery lesion in F. BLAST: Broad-use linear acquisition speed-up technique; CMR: Cardiovascular magnetic resonance.
Figure 4
Figure 4
Early and late gadolinium enhancement. A and B show a lateral sub-endocardial infarction on short axis and 4 chamber LGE respectively; C and D show a full thickness inferior infarction on LGE imaging on short axis and VLA respectively; E and F show EGE and LGE imaging respectively of a full thickness apical infarction with an apical thrombus appearing black (highlighted by red arrow); G shows an extensive acute antero-apical infarction with a core of microvascular obstruction visible within the hyperenhancement on EGE (red arrow); H shows an acute inferior wall infarction with MVO and extension into the right ventricle on LGE (red arrow) imaging. LGE: Late gadolinium enhancement; EGE: Early gadolinium enhancement; MVO: Mitral orifice.
See this image and copyright information in PMC

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