Magnetic resonance coronary angiography: present clinical applications

Coronary angiography is presently considered the gold standard test for the assessment of coronary artery disease. However, owing to the exposure to ionizing radiations, the invasiveness, and the incidence of major complications (0.3-1.1%), investigators are attempting to develop safer, non-invasive techniques. Cardiovascular magnetic resonance proved to be an extremely safe tool with a wide range of clinical applications. Its flexibility and non-invasiveness allow the evaluation of the heart and coronary arteries in one single setting, with the possibility of quantifying several cardiac physiological parameters. Multiple techniques have been applied to overcome the substantial difficulties in coronary artery imaging: respiration artifacts are suppressed by breath-holding or respiratory gating, cardiac motion artifacts are reduced by diastolic gating with ultra fast sequences and the signal-to-noise ratio can be increased with contrast agents. In several clinical trials, magnetic resonance coronary angiography has been successfully used to assess coronary artery stenoses, coronary artery bypass grafts and anomalous coronary artery origins and course. Considering the continuing developments in magnet coils, in software technology and in innovative imaging approaches, it is likely that magnetic resonance coronary angiography will in the future play an important role in the evaluation of coronary artery disease.