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Feasibility and Clinical Application of 5-T Noncontrast Dixon Whole-Heart Coronary MR Angiography: A Prospective
Hongfei Lu1, Xiyin Miao1, Dong Wang1
1From the Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai 200032, China (H.L., X.M., X.Z., X.Q., Y.C., H.J., M.Z.); Shanghai Institute of Medical Imaging, Shanghai, China (H.L., X.M., X.Z., X.Q., Y.C., H.J., M.Z.); United Imaging Healthcare, Shanghai, China (D.W., S.Z., R.W., G.L.); National Engineering Research Center of Advanced Magnetic Resonance Technologies for Diagnosis and Therapy, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (C.H.); and Department of Radiology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, China (H.J., M.Z.).
Abstract:
Background Coronary MR angiography (CMRA) at 3 T offers higher signal to noise ratio and contrast to noise ratio compared with 1.5 T. CMRA at 5 T may provide better diagnostic performance. Purpose To assess the feasibility and clinical application of 5-T noncontrast whole-heart CMRA and compare 5-T acquisition with 3-T acquisition. Materials and Methods From September 2023 to April 2024, patients scheduled for coronary CT angiography (CCTA) and volunteers were prospectively recruited. CCTA served as the reference standard in patients. CMRA was performed using a 3-T spectral attenuated inversion-recovery (3TSPAIR) sequence and 3-T Dixon (3TDixon) sequence with routine spatial resolution (3TSPAIR-routine and 3TDixon-routine, respectively), and 5-T Dixon (5TDixon) with routine and high spatial resolution (5TDixon-routine and 5TDixon-high, respectively). The study evaluated image quality, coronary artery calcium (CAC), the severity of coronary artery disease (CAD) graded according to Coronary Artery Disease Reporting and Data System, and the presence of ≥50% coronary stenosis. The nonparametric paired Wilcoxon signed rank test, McNemar test, generalized estimating equation model, and kappa test were used. Results Eight volunteers and 79 patients were included (mean age, 52 years ± 11 [SD]; 48 male). Image quality was higher for 5TDixon-routine compared with 3TSPAIR-routine and 3TDixon-routine (P < .001 for both) and similar for 5TDixon-high (P = .60). The per-segment sensitivity for CAC was higher at 5TDixon-high than 5TDixon-routine (78.3% vs 53.3%; P < .001), with no difference in specificity (98.6% vs 98.6%; P > .99). In grading the severity of CAD, 5TDixon-routine showed better consistency with CCTA than 3TSPAIR-routine (κ = 0.46 vs 0.13) and 3TDixon-routine (κ = 0.55 vs 0.42). For detecting ≥50% stenosis, the per-patient sensitivity, specificity, and accuracy were as follows: 5TDixon-routine versus 3TSPAIR-routine, 88.9% versus 55.6%, 86.5% versus 62.2%, and 87.0% versus 60.9% (P = .55, .01, and .18, respectively); 5TDixon-routine versus 3TDixon-routine, 90.0% versus 80.0%, 86.8% versus 71.1%, and 87.5% versus 72.9%, respectively (P > .05 for all). Conclusion Noncontrast CMRA at 5 T shows potential to evaluate CAC and coronary stenosis simultaneously and demonstrates superior diagnostic performance compared with at 3 T. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Rahsepar and Kim in this issue.
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