Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai, 200032, China.
Department of Radiology, Zhongshan Hospital (Minhang Meilong Branch), Fudan University and Shanghai Geriatric Medical Center, Shanghai, 200237, China.
J Cardiovasc Magn Reson. 2023 Nov 23;25(1):67. doi: 10.1186/s12968-023-00982-5.
The clinical application of coronary MR angiography (MRA) combining diastole and systole imaging has never been described comprehensively in coronary artery disease (CAD) patients. We aimed to design an optimal non-contrast coronary MRA scan protocol combining diastolic and systolic imaging and to (1) evaluate its diagnostic performance for detecting significant coronary stenosis; (2) evaluate the feasibility of this protocol to noninvasively measure the coronary distensibility index (CDI).
From June 2021 to May 2022, 33 healthy volunteers and 91 suspected CAD patients scheduled for X-ray coronary angiography (CAG) were prospectively enrolled. 3T non-contrast water-fat coronary MRA was carried out twice at diastole and systole. Significant coronary stenosis was defined as a luminal diameter reduction of ≥ 50% using CAG as the reference and was evaluated as follows: (1) by coronary MRA in diastole alone; (2) by coronary MRA in systole alone; (3) by combined coronary MRA in diastole and systole. According to CAG, the patients were divided into significant CAD patients and non-significant CAD patients. The difference in CDI among participants was evaluated.
Combined coronary MRA was completed in 31 volunteers and 76 patients. The per-patient sensitivity, specificity, and accuracy of combined coronary MRA were 97.5%, 83.3%, and 90.8%, respectively. Compared with single diastolic mode, combined coronary MRA showed equally high sensitivity but improved specificity on a per-patient basis (83.3% vs. 63.9%, adjusted P = 0.013). The CDI tested by coronary MRA decreased incrementally from healthy volunteers to non-significant and significant CAD patients.
Compared with single-phase mode, 3 T non-contrast combined coronary MRA significantly improved specificity and may have potential to be a simple noninvasive method to measure CDI.
冠状动脉磁共振血管造影（MRA）结合舒张期和收缩期成像的临床应用在冠状动脉疾病（CAD）患者中从未被全面描述过。我们旨在设计一种结合舒张期和收缩期成像的最佳非对比冠状动脉 MRA 扫描方案，并（1）评估其检测显著冠状动脉狭窄的诊断性能；（2）评估该方案无创测量冠状动脉扩张指数（CDI）的可行性。
从 2021 年 6 月至 2022 年 5 月，前瞻性纳入 33 名健康志愿者和 91 名疑似 CAD 患者。3T 非对比水脂冠状动脉 MRA 在舒张期和收缩期进行两次。采用冠状动脉造影（CAG）作为参考，将管腔直径缩小≥50%定义为显著冠状动脉狭窄，并进行如下评估：（1）仅舒张期冠状动脉 MRA；（2）仅收缩期冠状动脉 MRA；（3）舒张期和收缩期联合冠状动脉 MRA。根据 CAG，患者分为显著 CAD 患者和非显著 CAD 患者。评估参与者之间 CDI 的差异。
31 名志愿者和 76 名患者完成了联合冠状动脉 MRA。联合冠状动脉 MRA 的每位患者的敏感性、特异性和准确性分别为 97.5%、83.3%和 90.8%。与单纯舒张模式相比，联合冠状动脉 MRA在每位患者的基础上显示出同等高的敏感性，但特异性提高（83.3%比 63.9%，调整 P=0.013）。由冠状动脉 MRA 测试的 CDI 从健康志愿者到非显著和显著 CAD 患者逐渐降低。
与单相位模式相比，3T 非对比联合冠状动脉 MRA 显著提高了特异性，可能具有成为一种简单的无创测量 CDI 的方法的潜力。
