A Preliminary Report Comparing Magnetic Resonance Coronary Angiography with Conventional Angiography

BACKGROUND: The ability to assess the patency of coronary arteries by noninvasive means would represent an important advance. We have developed a magnetic resonance imaging (MRI) coronary angiographic technique that permits the display of areas of abnormal coronary blood flow. We have compared this method with conventional contrast angiography for the identification of coronary-artery stenoses. METHODS: MRI coronary angiography was performed with an electrocardiographically gated sequence in 39 subjects, 33 to 84 years of age, who were scheduled for elective cardiac catheterization with coronary angiography. Sequential overlapping transverse and oblique sections were acquired during periods of breath-holding and were displayed as cine loops for analysis. MRI and conventional angiographic data were compared in a blinded manner. The four major epicardial coronary arteries were classified by MRI coronary angiography as being normal (or having only minimal irregularities) or as having disease that was moderately severe to severe. RESULTS: The sensitivity and specificity of MRI coronary angiography, as compared with conventional angiography, for correctly identifying individual vessels with > or = 50 percent angiographic stenoses were 90 percent and 92 percent, respectively. The corresponding positive and negative predictive values were 0.85 and 0.95, respectively. The sensitivity and specificity of the technique were 100 percent and 100 percent, respectively, for the left main coronary artery, 87 percent and 92 percent for the left anterior descending coronary artery, 71 percent and 90 percent for the left circumflex coronary artery, and 100 percent and 78 percent for the right coronary artery. CONCLUSIONS: MRI coronary angiography provides a new approach to evaluating the patency of coronary arteries. These preliminary data suggest that this technique may provide a noninvasive means of evaluating patients with known or suspected coronary artery disease. At its current stage of development, this procedure may be most helpful for excluding clinically important stenoses in patients referred for diagnostic contrast angiography.