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Improved Visualization of Coronary Arteries Using a New Three-Dimensional Submillimeter MR Coronary Angiography Sequence with Balanced Gradients

¹ Department of Radiology, Gasthuisberg University Hospital, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
² ESAT-PSI, Gasthuisberg University Hospital, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
³ Philips Medical Systems, Veenpluis 4-6, 5680 DA Best, The Netherlands.

View larger version (11K): [in a new window]   Fig. 1. —Diagram shows timing and order of sequence elements used for balanced turbo field-echo scout image (second scan) and submillimeter MR coronary angiograms (third through sixth scans). Dotted boxes = timing of acquisition in heart cycle, 2D = two dimensional.

View larger version (150K): [in a new window]   Fig. 2A. —Three-dimensional MR coronary angiograms of 31-year-old healthy male volunteer. Turbo field-echo MR coronary angiograms (A) and balanced turbo field-echo MR coronary angiograms (B) show course of right coronary artery; twelve of 20 original images are shown (voxel size, 0.54 x 0.54 x 1.5 mm). B shows less homogeneous signal for blood in heart chambers, pulmonary artery, and ascending aorta than A but better suppression of myocardial tissue signal. Left circumflex coronary artery (long arrows) and their side branches, as well as right coronary artery (short arrows), are more clearly visualized along longer part on B than on A.

View larger version (162K): [in a new window]   Fig. 2B. —Three-dimensional MR coronary angiograms of 31-year-old healthy male volunteer. Turbo field-echo MR coronary angiograms (A) and balanced turbo field-echo MR coronary angiograms (B) show course of right coronary artery; twelve of 20 original images are shown (voxel size, 0.54 x 0.54 x 1.5 mm). B shows less homogeneous signal for blood in heart chambers, pulmonary artery, and ascending aorta than A but better suppression of myocardial tissue signal. Left circumflex coronary artery (long arrows) and their side branches, as well as right coronary artery (short arrows), are more clearly visualized along longer part on B than on A.

View larger version (20K): [in a new window]   Fig. 3A. —Segmental image quality (i.e., per 3 cm) per coronary artery is shown using 5-point grading system (1, nondiagnostic or unreadable; 2, poor; 3, moderate; 4, good; 5, excellent). Because of variable length in visualization of coronary arteries on both sequences, number of visible segments is shown for each sequence at bottom of column. Bar graphs show image quality assessment for left main coronary artery (A), left anterior descending coronary artery (B), left circumflex coronary artery (C), and right coronary artery (D). Dotted bars = turbo-field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (27K): [in a new window]   Fig. 3B. —Segmental image quality (i.e., per 3 cm) per coronary artery is shown using 5-point grading system (1, nondiagnostic or unreadable; 2, poor; 3, moderate; 4, good; 5, excellent). Because of variable length in visualization of coronary arteries on both sequences, number of visible segments is shown for each sequence at bottom of column. Bar graphs show image quality assessment for left main coronary artery (A), left anterior descending coronary artery (B), left circumflex coronary artery (C), and right coronary artery (D). Dotted bars = turbo-field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (26K): [in a new window]   Fig. 3C. —Segmental image quality (i.e., per 3 cm) per coronary artery is shown using 5-point grading system (1, nondiagnostic or unreadable; 2, poor; 3, moderate; 4, good; 5, excellent). Because of variable length in visualization of coronary arteries on both sequences, number of visible segments is shown for each sequence at bottom of column. Bar graphs show image quality assessment for left main coronary artery (A), left anterior descending coronary artery (B), left circumflex coronary artery (C), and right coronary artery (D). Dotted bars = turbo-field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (26K): [in a new window]   Fig. 3D. —Segmental image quality (i.e., per 3 cm) per coronary artery is shown using 5-point grading system (1, nondiagnostic or unreadable; 2, poor; 3, moderate; 4, good; 5, excellent). Because of variable length in visualization of coronary arteries on both sequences, number of visible segments is shown for each sequence at bottom of column. Bar graphs show image quality assessment for left main coronary artery (A), left anterior descending coronary artery (B), left circumflex coronary artery (C), and right coronary artery (D). Dotted bars = turbo-field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (26K): [in a new window]   Fig. 4A. —Bar graphs show diameter, length, and number of side branches for each coronary artery. Diameter (A), length (B), and number of side branches (C) are shown for left main (LM), left anterior descending (LAD), left circumflex (LCx), and right (R) coronary arteries. Dotted bars = turbo field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (23K): [in a new window]   Fig. 4B. —Bar graphs show diameter, length, and number of side branches for each coronary artery. Diameter (A), length (B), and number of side branches (C) are shown for left main (LM), left anterior descending (LAD), left circumflex (LCx), and right (R) coronary arteries. Dotted bars = turbo field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (21K): [in a new window]   Fig. 4C. —Bar graphs show diameter, length, and number of side branches for each coronary artery. Diameter (A), length (B), and number of side branches (C) are shown for left main (LM), left anterior descending (LAD), left circumflex (LCx), and right (R) coronary arteries. Dotted bars = turbo field-echo sequence, white bars = balanced turbo field-echo sequence.

View larger version (174K): [in a new window]   Fig. 5A. —Three-dimensional MR coronary angiograms of left anterior descending coronary artery using 5-mm maximum-intensity-projection views of 28-year-old healthy male volunteer. Turbo field-echo MR coronary angiogram (A) and balanced turbo-field MR coronary angiogram (B) show course of left anterior descending coronary artery (arrows). Note better visualization of left anterior descending coronary artery in B, mainly because of improved vessel sharpness and contrast.

View larger version (185K): [in a new window]   Fig. 5B. —Three-dimensional MR coronary angiograms of left anterior descending coronary artery using 5-mm maximum-intensity-projection views of 28-year-old healthy male volunteer. Turbo field-echo MR coronary angiogram (A) and balanced turbo-field MR coronary angiogram (B) show course of left anterior descending coronary artery (arrows). Note better visualization of left anterior descending coronary artery in B, mainly because of improved vessel sharpness and contrast.

View larger version (167K): [in a new window]   Fig. 6A. —Three-dimensional MR coronary angiograms of left anterior descending coronary artery using 5-mm maximum-intensity-projection views of 32-year-old healthy female volunteer. Turbo field-echo MR coronary angiogram (A) and balanced turbo field-echo MR coronary angiogram (B) show left anterior descending coronary artery (arrows). Note improved visualization of first diagonal branch (asterisks) of left anterior descending coronary artery in B. Note improved sharpness of left pulmonary vessels and higher signal of left-sided pleural effusion in B.

View larger version (169K): [in a new window]   Fig. 6B. —Three-dimensional MR coronary angiograms of left anterior descending coronary artery using 5-mm maximum-intensity-projection views of 32-year-old healthy female volunteer. Turbo field-echo MR coronary angiogram (A) and balanced turbo field-echo MR coronary angiogram (B) show left anterior descending coronary artery (arrows). Note improved visualization of first diagonal branch (asterisks) of left anterior descending coronary artery in B. Note improved sharpness of left pulmonary vessels and higher signal of left-sided pleural effusion in B.

View larger version (177K): [in a new window]   Fig. 7A. —Three-dimensional MR coronary angiograms of right coronary artery using 5-mm maximum-intensity-projection views of 30-year-old healthy male volunteer. Right coronary artery is depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

View larger version (180K): [in a new window]   Fig. 7B. —Three-dimensional MR coronary angiograms of right coronary artery using 5-mm maximum-intensity-projection views of 30-year-old healthy male volunteer. Right coronary artery is depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

View larger version (173K): [in a new window]   Fig. 8A. —Three-dimensional MR coronary angiograms of right coronary artery of 29-year-old healthy female volunteer. Right coronary artery was depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

View larger version (179K): [in a new window]   Fig. 8B. —Three-dimensional MR coronary angiograms of right coronary artery of 29-year-old healthy female volunteer. Right coronary artery was depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

View larger version (177K): [in a new window]   Fig. 9A. —Three-dimensional MR coronary angiograms of right coronary artery using 4-mm maximum-intensity-projection views of 28-year-old healthy male volunteer. Right coronary artery was depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

View larger version (192K): [in a new window]   Fig. 9B. —Three-dimensional MR coronary angiograms of right coronary artery using 4-mm maximum-intensity-projection views of 28-year-old healthy male volunteer. Right coronary artery was depicted more sharply on balanced turbo field-echo MR coronary angiogram (B), with increased depiction of vessel length and visualization of right coronary artery in inferior part of right atrioventricular groove (arrows), than in turbo field-echo MR coronary angiogram (A).

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