Korean J Radiol.  2011 Dec;12(6):679-685. 10.3348/kjr.2011.12.6.679.

3D Whole-Heart Coronary MR Angiography at 1.5T in Healthy Volunteers: Comparison between Unenhanced SSFP and Gd-Enhanced FLASH Sequences

• Gweon HM
• Kim SJ
• Lee SM
• Hong YJ
• Kim TH

• KMID: 1101921
• DOI: http://doi.org/10.3348/kjr.2011.12.6.679

Abstract

OBJECTIVE
To validate the optimal cardiac phase and appropriate acquisition window for three-dimensional (3D) whole-heart coronary magnetic resonance angiography (MRA) with a steady-state free precession (SSFP) sequence, and to compare image quality between SSFP and Gd-enhanced fast low-angle shot (FLASH) MR techniques at 1.5 Tesla (T).
MATERIALS AND METHODS
Thirty healthy volunteers (M:F = 25:5; mean age, 35 years; range, 24-54 years) underwent a coronary MRA at 1.5T. 3D whole-heart coronary MRA with an SSFP was performed at three different times: 1) at end-systole with a narrow (120-msec) acquisition window (ESN), 2) mid-diastole with narrow acquisition (MDN); and 3) mid-diastole with wide (170-msec) acquisition (MDW). All volunteers underwent a contrast enhanced coronary MRA after undergoing an unenhanced 3D true fast imaging with steady-state precession (FISP) MRA three times. A contrast enhanced coronary MRA with FLASH was performed during MDN. Visibility of the coronary artery and image quality were evaluated for 11 segments, as suggested by the American Heart Association. Image quality was scored by a five-point scale (1 = not visible to 5 = excellent). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated at the proximal coronary arteries.
RESULTS
The SSFP sequence rendered higher visibility coronary segments, higher image quality, as well as higher SNR and CNR than the Gd-enhanced FLASH technique at 1.5T (p < 0.05). The visibility of coronary segments, image quality, SNR and CNR in the ESN, MDN and MDW with SSFP sequence did not differ significantly.
CONCLUSION
An SSFP sequence provides an excellent method for the 3D whole-heart coronary MRA at 1.5T. Contrast enhanced coronary MRA using the FLASH sequence does not help improve the visibility of coronary segments, image quality, SNR or CNR on the 3D whole-heart coronary MRA.

Keyword

Cardiac magnetic resonance; Coronary artery imaging; Steady-state free precession; Fast low-angle shot; Contrast agent; 1.5T

MeSH Terms

Adult
*Contrast Media
Coronary Vessels/*anatomy & histology
Female
Gadolinium/diagnostic use
Humans
Image Processing, Computer-Assisted
*Imaging, Three-Dimensional
Magnetic Resonance Angiography/*methods
Male
Middle Aged
Organometallic Compounds/*diagnostic use
Reference Values
Young Adult

Figure

• 

  Fig. 1 Schematic diagram of cardiac phase and acquisition window optimization for 3D whole-heart coronary MR angiography with steady-state free precession sequence: end-systole with narrow (120-msec) acquisition window (ESN); mid-diastole with narrow acquisition (MDN); and mid-diastole with wide (170-msec) acquisition window (MDW). Gd-enhanced coronary MR angiography with fast low-angle shot technique was performed in mid-diastole with narrow acquisition condition.

• 

  Fig. 2 Volume rendered and curved multiplanar reformatted images of coronary arteries from 3D whole-heart coronary MR angiography at 1.5T. Right and left coronary arteries including posterior descending artery were well-defined on volume rendered (A, B) and curved multiplanar reconstruction (C, D) images obtained at mid-diastole with narrow acquisition. However, right coronary artery and posterior descending artery were blurred on curved multiplanar reformatted image obtained using Gd-enhanced MR angiography at mid-diastole with narrow acquisition, which showed lower signal-to-noise and contrast-to-noise ratios (E).

• 

  Fig. 3 Graph represents mean image quality scores for coronary artery segments based on five-point scale: 1, not visible; 2, poor; 3, fair; 4, good; and 5, excellent. Images obtained at end-systole with narrow acquisition (ESN), mid-diastole with narrow acquisition (MDN), and mid-diastole with wide acquisition (MDW) did not differ significantly in quality. Gd-enhanced MR angiography at mid-diastole with narrow acquisition (Gd-MDN) produced coronary artery images significantly lower in quality than those obtained by other three methods with steady-state free precession (p < 0.01). Numbers in parenthesis were mean image scores.

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