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Magnetic Resonance Angiography for CAD

This technology shows promise for detecting coronary stenoses.

The search for noninvasive methods of detecting coronary artery disease (CAD) continues. With advances in imaging technology, cardiac catheterization may eventually be replaced; studies have already demonstrated that coronary magnetic resonance angiography (MRA) can enable visualization of the major epicardial arteries.

To assess the current generation of scanners, researchers conducted a prospective, 7-center, international study. Subjects were 109 patients (minimum age, 21; maximum weight, 100 kg) in sinus rhythm who were scheduled for coronary angiography within 2 weeks. Each center used a 1.5-T system equipped with PowerTrak 6000 gradients. The mean total scan time was 70 minutes. (The study was supported, in part, by the maker of the scanning system.)

Overall, 759 coronary segments were potentially available for analysis; 84% could be assessed by MRA. Of the 94 segments with clinically significant disease (50% stenosis on coronary angiography), 78 (83%) were detected by MRA (sensitivity, 93%; specificity, 42%). Four patients had clinically significant coronary disease that MRA did not detect; all 4 had isolated single-vessel disease, including 2 with circumflex disease.

Comment: These authors tout MRA as having a role in ruling out clinically significant disease in certain subgroups, including patients with severe LV systolic dysfunction but without prior MI. The technology is likely to improve, and the present results do show some promise. The editorialists say that it is simply a question of when -- not if -- such techniques will be an alternative to the standard invasive approach for selected patients.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology February 15, 2002

Citation(s):

Kim WY et al. Coronary magnetic resonance angiography for the detection of coronary stenoses. N Engl J Med 2001 Dec 27; 345:1863-9.

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Achenbach S and Daniel WG. Noninvasive coronary angiography -- An acceptable alternative? N Engl J Med 2001 Dec 27; 345:1909-10.

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• Medline abstract (Free)