Jahnke Cosima, Paetsch Ingo, Schnackenburg Bernhard, Bornstedt Axel, Gebker Rolf, Fleck Eckart, Nagel Eike
Department of Internal Medicine/Cardiology, German Heart Institute, Berlin, Germany.
Radiology. 2004 Sep;232(3):669-76. doi: 10.1148/radiol.2323031225. Epub 2004 Jul 29.
To compare image quality and coronary artery stenosis detection with breath-hold (BH) and free-breathing navigator-gated (NAV) coronary magnetic resonance (MR) angiography performed with the same imaging sequence (steady-state free precession) and identical spatial resolution in patients suspected of having coronary artery disease.
Forty consecutive patients suspected of having coronary artery disease underwent steady-state free precession MR imaging of the left or the right coronary artery twice. Correction of breathing motion was performed once with NAV and again with BH. Maximal BH duration and coronary artery rest period were individually determined, and duration of data acquisition was adapted (parallel imaging with different sensitivity encoding factors was used). Quantitative analysis of coronary MR angiography data was performed with multiplanar reformatting software to determine visual score for image quality, vessel sharpness, visible vessel length, and number of visible side branches. Diagnostic accuracy for detection of coronary stenosis of 50% or greater was determined in comparison with results of conventional invasive angiography. The two techniques were compared regarding differences in angiographic parameters with paired Student t testing. chi(2) or Fisher exact testing was used when appropriate.
More coronary artery segments were assessable with NAV than with BH MR angiography (254 [79.4%] vs 143 [44.7%] of 320 segments). Overall sensitivity and specificity with NAV were 72% (26 of 36 segments) and 91.7% (200 of 218 segments), versus 63% (12 of 19 segments) and 82.3% (102 of 124 segments) with BH; NAV enabled correct diagnosis in 13% more segments. BH yielded nondiagnostic images in 14 patients, while NAV yielded diagnostic images in all patients. When these 14 patients were excluded, there was a significant increase in visual score for left (3.0 vs 2.4, P <.01) and right (3.3 vs 3.0, P <.05) coronary arteries and no significant difference in vessel sharpness but significant improvement in visible vessel length in left coronary artery (85.9 vs 71.4 mm, P =.003) and number of visible side branches in left (4.9 vs 3.9, P =.04) and right (2.8 vs 2.4, P =.04) coronary arteries on NAV images as compared with BH images.
Free-breathing NAV was superior to BH coronary MR angiography in terms of image quality and diagnostic accuracy of stenosis detection.
在疑似患有冠状动脉疾病的患者中，比较采用相同成像序列（稳态自由进动）和相同空间分辨率的屏气（BH）和自由呼吸导航门控（NAV）冠状动脉磁共振（MR）血管造影的图像质量和冠状动脉狭窄检测情况。
40例连续的疑似患有冠状动脉疾病的患者对左或右冠状动脉进行了两次稳态自由进动MR成像。呼吸运动校正一次采用NAV，另一次采用BH。分别确定最大屏气持续时间和冠状动脉静止期，并调整数据采集持续时间（使用具有不同灵敏度编码因子的并行成像）。使用多平面重组软件对冠状动脉MR血管造影数据进行定量分析，以确定图像质量、血管清晰度、可见血管长度和可见侧支数量的视觉评分。与传统有创血管造影结果相比，确定检测50%或更严重冠状动脉狭窄的诊断准确性。采用配对学生t检验比较两种技术在血管造影参数上的差异。适当情况下使用χ²检验或Fisher精确检验。
与BH MR血管造影相比，NAV可评估的冠状动脉节段更多（320个节段中分别为254个[79.4%]和143个[44.7%]）。NAV的总体敏感性和特异性分别为72%（36个节段中的26个）和91.7%（218个节段中的200个），而BH分别为63%（19个节段中的12个）和82.3%（124个节段中的102个）；NAV能使多13%的节段得到正确诊断。BH在14例患者中产生了无法诊断的图像，而NAV在所有患者中均产生了可诊断的图像。当排除这14例患者后，左冠状动脉（3.0对2.4，P<.01）和右冠状动脉（3.3对3.0，P<.05）的视觉评分显著提高，血管清晰度无显著差异，但与BH图像相比，NAV图像上左冠状动脉的可见血管长度显著改善（85.9对71.4mm，P=.003），左冠状动脉（4.9对3.9，P=.04）和右冠状动脉（2.8对2.4，P=.04）的可见侧支数量显著增加。
在图像质量和狭窄检测的诊断准确性方面，自由呼吸NAV优于BH冠状动脉MR血管造影。
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