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MR imaging of the aortic root and proximal coronary arteries
Abstract:
Six patients who had recently undergone selective coronary and left ventricular angiography were prospectively examined with MR to show the aortic root and proximal coronary arteries. The examinations were performed with a superconductive 1.5-T instrument with spin-echo sequences and ECG-gated multiple slices of 5-mm thickness. The location and plane direction of the scan were guided by findings on initial coronary MR scout scans and by a review of the angiograms. In four of the six patients both coronary orifices and the proximal centimeters of both coronary arteries were identified. In the remaining two, only the left proximal coronary artery was seen. Although segments of more peripherally located portions of the main coronary arteries and branches were detectable, a prospective and conclusive identification without knowledge of the angiographic anatomy would have been extremely difficult. Differential diagnostic problems, such as erroneous interpretation of pericardial recesses and coronary veins, were observed. Unsuccessful demonstration of the right coronary artery orifice in two cases coincided with more peripherally located occlusion of the vessels on the angiogram. MR with spin-echo sequences appears to be unsatisfactory for diagnosis of coronary arteriosclerotic disease, but it may be useful in other conditions that result in significant coronary dilatation, such as fistulae and aneurysms.
Insights
Magnetic resonance (MR) imaging with spin-echo sequences showed limited success in visualizing coronary arteries in patients. This technique may be better suited for detecting coronary artery dilation rather than arteriosclerotic disease.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
Background:
- Selective coronary angiography is a standard diagnostic tool.
- Magnetic resonance (MR) imaging offers a non-invasive alternative for cardiovascular assessment.
Purpose of the Study:
- To prospectively evaluate the efficacy of MR imaging in visualizing the aortic root and proximal coronary arteries.
- To assess the diagnostic potential of MR spin-echo sequences for coronary artery visualization.
Main Methods:
- Six patients recently undergoing coronary angiography were examined using a 1.5-T MR scanner.
- Spin-echo sequences with ECG-gating and 5-mm slice thickness were employed.
- Scan parameters were guided by initial MR scout scans and review of angiograms.
Main Results:
- Coronary orifices and proximal coronary arteries were identified in 4 out of 6 patients.
- The left proximal coronary artery was visualized in 2 additional patients.
- Detection of distal segments was challenging, and differential diagnoses included pericardial recesses and coronary veins.
Conclusions:
- MR spin-echo sequences are currently unsatisfactory for diagnosing coronary arteriosclerotic disease.
- MR imaging may have utility in identifying coronary artery abnormalities like fistulae and aneurysms causing significant dilatation.