Acute One-Stop Cardiovascular Magnetic Resonance Imaging for Differential Diagnosis in Patients with Acute Coronary Syndrome and Unobstructed Coronary Arteries.

OBJECTIVE

We aimed to evaluate the contributions of acute one-stop cardiovascular magnetic resonance (CMR) imaging to the differential diagnosis of acute coronary syndrome (ACS) and unobstructed coronary arteries.

SUBJECTS AND METHODS

In this study, 32 consecutive patients who presented with ACS and unobstructed coronary arteries on angiography were enrolled between January 2010 and December 2012. Acute one-stop CMR, including cine, angiography, black-blood, first-pass perfusion and late gadolinium enhancement (LGE) imaging, was performed with a pre-specified algorithm which was decided on by the doctors for all patients. The intimal flap in the aorta and the filling defect in the pulmonary artery were detected on MR angiography imaging. Left ventricular wall motion and ventricular thickness were analyzed in cine-mode sequences. The LGE images were reviewed for the presence, anatomical distribution and extent of contrast enhancement.

RESULTS

The acute one-stop CMR study was completed in all the 32 patients without adverse events. The overall time duration was between 15 and 60 min. Of the 32 patients, a CMR diagnosis was made in 30 (93.8%). Aortic dissection was detected in 3 patients, pulmonary embolism in 2, hypertrophic cardiomyopathy in 2, acute myocardial infarction in 5, acute myocarditis in 16 and stress cardiomyopathy in 2. No confirmed diagnosis was established in the remaining 2 patients with normal CMR.

CONCLUSION

Acute one-stop CMR allowed for the identification of an aetiology in most of the patients in this study. It may prove to be of immense help in establishing a differential diagnosis in patients presenting with acute chest pain, elevated troponin I and normal coronary arteries.