Korean Circ J.  2017 May;47(3):409-412. 10.4070/kcj.2016.0288.

Additive Role of Coronary Magnetic Resonance Angiography for the Evaluation of Coronary Artery Disease

• Kim MJ
• Yoon YE
• Park JJ
• Kim YK
• Chun EJ
• Choi SI
• Cho GY

• KMID: 2385396
• DOI: http://doi.org/10.4070/kcj.2016.0288

Abstract

Coronary magnetic resonance angiography (CMRA) allows a noninvasive assessment of the coronary anatomy without exposing the patients to radiation. It is also superior to coronary computed tomography angiography (CCTA) for the evaluation of luminal narrowing in heavily calcified coronary segments. We report a case with triple-vessel disease, but it could not be accurately assessed by CCTA because of calcification and lack of a significant perfusion defect or myocardial scarring on cardiac magnetic resonance imaging (MRI). However, whole-heart CMRA performed as part of the cardiac MRI protocol demonstrated significant triple-vessel disease with left main involvement, confirmed by subsequent invasive angiography with a fractional flow reserve measurement.

Keyword

Coronary artery disease; Magnetic resonance angiography

MeSH Terms

Angiography
Cicatrix
Coronary Artery Disease*
Coronary Vessels*
Humans
Magnetic Resonance Angiography*
Magnetic Resonance Imaging
Perfusion
Phenobarbital
Phenobarbital

Figure

• 

  Fig. 1 CCTA, CMRA, and invasive CAG findings. CCTA revealed multifocal coronary artery disease in the left main bifurcation (A, D, arrowheads), proximal left anterior descending artery (A, arrow), proximal left circumflex artery (D, dotted arrow), and mid right coronary artery (G, open arrowhead). Although the CCTA evaluation of the stenosis severity was limited because of calcification (A, D, G), whole-heart CMRA demonstrated significant stenoses of the left main bifurcation (B, E, arrowheads), proximal left circumflex artery (E, dotted arrow), and mid right coronary artery (H, open arrowhead). On the other hand, the calcified plaque in the proximal left anterior descending artery was indicated as an insignificant lesion on CMRA (B, arrow). Good agreement was observed between CMRA and subsequent CAG (C, F, I). CCTA: coronary computed tomography angiography, CMRA: coronary magnetic resonance angiography, CAG: coronary angiography.

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  Fig. 2 Stress and rest myocardial perfusion magnetic resonance imaging findings. There was no evidence of inducible myocardial ischemia on myocardial perfusion magnetic resonance imaging (Also see Supplementary Video. 1, 2, 3, 4, 5, 6 in the online-only Data Supplement).

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