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Feasibility of Integrating High-Spatial-Resolution 3D Breath-hold Coronary MR Angiography with Myocardial Perfusion and Viability Examinations¹

¹ From the Applied Science Laboratory, GE Healthcare Technologies, Room 110-MRI, 600 N Wolfe St, Baltimore, MD 21287 (T.K.F.F., M.S.); Dept of Radiology and Radiological Sciences, Uniformed Services Univ of the Health Sciences, Bethesda, Md (V.B.H.); Dept of Radiology, Chinese PLA General Hosp, Beijing, China (L.C.); Dept of Radiology, Mie Univ, Tsu, Japan (H.S.); and Dept of Radiology (D.L.K., D.A.B.) and Div of Cardiology (K.C.W.), Johns Hopkins Univ, Baltimore, Md. Received Jan 19, 2004; revision requested Mar 19; final revision received Aug 9; accepted Sep 2. Research grant by GE Healthcare Technologies (V.B.H.) and Bracco Diagnostics (V.B.H., D.A.B.). Address correspondence to T.K.F.F. (e-mail: thomas.foo@med.ge.com).

View larger version (18K): [in a new window]   Figure 1. Diagram of pulse sequence illustrates the relative positions of the spectrally selective inversion radiofrequency (rf) pulse phase, the dummy excitation and half (/2)-half repetition time (TR/2) phases, and the data acquisition phase. Two imaging segments per section-encoding view are carried out, with the central k-space views acquired in a smaller temporal window than the higher k-space views. The preparation segment was used to accelerate the approach to steady state and minimize signal intensity variations during data acquisition. kr = spatial frequency encoding views.

View larger version (165K): [in a new window]   Figure 2a. Single 2.0-mm MR images (4.7/1.9, 26-cm field of view, 256 x 224 matrix, 1.0 x 1.1 x 2.0-mm acquired voxels) obtained from (a) precontrast and (b) postcontrast 3D volume acquisitions (12 sections) in 60-year-old man. Each volume was acquired during a 19-second breath hold (heart rate, 75 beats per minute). Vessel SNR in the RCA (arrow) increased from 48 before to 80 after a cumulative 0.2 mmol/kg dose of gadolinium-based contrast material was administered. This represented a 1.6-fold increase in vessel SNR approximately 5 minutes after contrast material administration (ie, after second 0.10 mmol/kg injection).

View larger version (166K): [in a new window]   Figure 2b. Single 2.0-mm MR images (4.7/1.9, 26-cm field of view, 256 x 224 matrix, 1.0 x 1.1 x 2.0-mm acquired voxels) obtained from (a) precontrast and (b) postcontrast 3D volume acquisitions (12 sections) in 60-year-old man. Each volume was acquired during a 19-second breath hold (heart rate, 75 beats per minute). Vessel SNR in the RCA (arrow) increased from 48 before to 80 after a cumulative 0.2 mmol/kg dose of gadolinium-based contrast material was administered. This represented a 1.6-fold increase in vessel SNR approximately 5 minutes after contrast material administration (ie, after second 0.10 mmol/kg injection).

View larger version (166K): [in a new window]   Figure 3a. MR images obtained in 58-year-old man show results of (a) first-pass myocardial perfusion imaging combined with (b, c) 3D targeted breath-hold coronary MR angiography and (d) delayed-enhancement (viability assessment) imaging during a single examination (4.6/1.8, 26-cm field of view, 12 2.4-mm sections interpolated to 24 1.2-mm sections, 256 x 224 matrix, spatial resolution of 1.10 x 1.16 x 2.4 mm, acquisition completed during 21-second breath hold at heart rate of 70 beats per minute). (a) At-rest perfusion images show low-enhancing regions (arrows) indicative of a regional perfusion deficit. (b, c) Multiplanar reformations of the LCX artery (arrow) (b) and the RCA (arrow) (c) were obtained before the myocardial viability examination. (d) Three-dimensional delayed-enhancement images acquired during a single breath hold show high-enhancing areas (arrows) indicative of myocardial infarction that correspond to the regions of perfusion deficit in a.

View larger version (79K): [in a new window]   Figure 3b. MR images obtained in 58-year-old man show results of (a) first-pass myocardial perfusion imaging combined with (b, c) 3D targeted breath-hold coronary MR angiography and (d) delayed-enhancement (viability assessment) imaging during a single examination (4.6/1.8, 26-cm field of view, 12 2.4-mm sections interpolated to 24 1.2-mm sections, 256 x 224 matrix, spatial resolution of 1.10 x 1.16 x 2.4 mm, acquisition completed during 21-second breath hold at heart rate of 70 beats per minute). (a) At-rest perfusion images show low-enhancing regions (arrows) indicative of a regional perfusion deficit. (b, c) Multiplanar reformations of the LCX artery (arrow) (b) and the RCA (arrow) (c) were obtained before the myocardial viability examination. (d) Three-dimensional delayed-enhancement images acquired during a single breath hold show high-enhancing areas (arrows) indicative of myocardial infarction that correspond to the regions of perfusion deficit in a.

View larger version (133K): [in a new window]   Figure 3c. MR images obtained in 58-year-old man show results of (a) first-pass myocardial perfusion imaging combined with (b, c) 3D targeted breath-hold coronary MR angiography and (d) delayed-enhancement (viability assessment) imaging during a single examination (4.6/1.8, 26-cm field of view, 12 2.4-mm sections interpolated to 24 1.2-mm sections, 256 x 224 matrix, spatial resolution of 1.10 x 1.16 x 2.4 mm, acquisition completed during 21-second breath hold at heart rate of 70 beats per minute). (a) At-rest perfusion images show low-enhancing regions (arrows) indicative of a regional perfusion deficit. (b, c) Multiplanar reformations of the LCX artery (arrow) (b) and the RCA (arrow) (c) were obtained before the myocardial viability examination. (d) Three-dimensional delayed-enhancement images acquired during a single breath hold show high-enhancing areas (arrows) indicative of myocardial infarction that correspond to the regions of perfusion deficit in a.

View larger version (210K): [in a new window]   Figure 3d. MR images obtained in 58-year-old man show results of (a) first-pass myocardial perfusion imaging combined with (b, c) 3D targeted breath-hold coronary MR angiography and (d) delayed-enhancement (viability assessment) imaging during a single examination (4.6/1.8, 26-cm field of view, 12 2.4-mm sections interpolated to 24 1.2-mm sections, 256 x 224 matrix, spatial resolution of 1.10 x 1.16 x 2.4 mm, acquisition completed during 21-second breath hold at heart rate of 70 beats per minute). (a) At-rest perfusion images show low-enhancing regions (arrows) indicative of a regional perfusion deficit. (b, c) Multiplanar reformations of the LCX artery (arrow) (b) and the RCA (arrow) (c) were obtained before the myocardial viability examination. (d) Three-dimensional delayed-enhancement images acquired during a single breath hold show high-enhancing areas (arrows) indicative of myocardial infarction that correspond to the regions of perfusion deficit in a.