Advances in Coronary MRA from Vessel Wall to Whole Heart Imaging

Since its introduction, magnetic resonance (MR) imaging has undergone continued technical and methodological development and found numerous practical clinical applications. Cardiac MR imaging is one of the more sophisticated applications of MR, owing to the inherent presence of flow and motion and specific anatomy. Among the different categories of cardiac MR imaging, coronary MR angiography (MRA) places particularly high demands on planning, spatial resolution, high signal-to-noise ratio (SNR), and precise cardiac and respiratory motion correction. However, recent advances in hardware, MR sequences, and motion detection techniques have made it possible to perform coronary MRA that includes volumetric acquisition of the entire heart as well as imaging of the vessel walls on a submillimeter scale within a clinically acceptable scan time. We discuss from a technical perspective some of the milestones leading to the current state of coronary MR imaging and outline recent developments that will further advance coronary MR imaging. We discuss planning procedure, contrast preparation mechanisms and MR sequences, motion correction, high-resolution coronary artery and vessel wall imaging, and fast volumetric scanning techniques. Although MR imaging has certain limitations in providing simultaneous speed, resolution, and high SNR, it nonetheless offers a dedicated scanning procedure that addresses most clinically relevant questions in the diagnosis of ischemic heart disease.