MR imaging of the aortic root and proximal coronary arteries

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.