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Coronary Magnetic Resonance Angiography

Beth Israel Medical Center New York, NY 10003

Edited by André J. Duerinckx. New York: Springer-Verlag, 357 pp., 2002. $198

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For the past 20 years, we have witnessed a revolution in cardiovascular imaging. The introduction of vascular sonography and MR imaging has changed not only the manner in which we look at arteries but also arterial disease itself. In no vascular bed has the revolution held more promise of a faster, less costly, more accurate, and relevant diagnosis than in the coronary arteries. However, the spread of MR techniques through the cardiovascular system always seemed to stop at the heart. Even as the use and role of MR imaging for diagnosis of acquired and congenital heart disease increased in volume and relevance, visualization of the epicardial coronary arteries, and especially detection of atherosclerotic stenosis and occlusion, remained difficult and of limited clinical usefulness. With each new generation of MR scanner and pulse sequence, however, groups of physicist, radiologist, and cardiologist pioneers took these new tools and continued their assault on coronary arterial imaging. And despite their limited success, interest in future successes, perceived turf, and technical expertise drove these individuals and groups to press on.

Andre Duerinckx has been involved with the practice and growth of cardiac and coronary arterial MR imaging nearly from its beginning. It is appropriate that he has edited a new textbook on the subject. Coronary Magnetic Resonance Angiography is a collection of detailed discussions covering all aspects of the physical principles and clinical practice of MR coronary arteriography. Dr. Duerinckx wrote or contributed to 17 of the 32 chapters in this text, which begins with a description of the anatomy and physiology of the coronary arteries, principles and techniques of coronary MR imaging, and indications for its use. Duerinckx describes principles of pulse sequence design and implementation for coronary MR angiography in two chapters. He discusses two-dimensional image acquisition and its implementation and then extends his arguments to a discussion of three-dimensional acquisition. Many of the clinical aspects of coronary MR angiography are presented in pairs of chapters on specific clinical subjects. For example, MR imaging of coronary arterial bypass grafts; free-breathing MR coronary arteriography; coronary flow, flow reserve, and their measurements; and MR contrast agents are presented from the perspectives of different intellectual approaches to the clinical problem and different clinical practice in each group.

There are no pro and con debates but, rather, complementary discussions emphasizing both the engineering and physiologic aspects of relevant pulse sequences and their use and value for solving clinical problems. In addition, the text contains chapters on the use of coronary MR angiography in specific clinical settings, including for evaluation of suspected congenital coronary anomalies and of adult patients suspected of having congenital heart disease. Three chapters on alternative methods of coronary imaging (including intravascular sonography and electron-beam CT) and two chapters on ventricular function complement the emphasis on coronary luminal visualization.

The book is well organized and covers the technical principles of MR imaging, with significant emphasis on those principles that are relevant to imaging the beating heart. The text is extremely well annotated and includes a complete review of the medical literature in this young but growing field. The figures are all of the highest quality and relevant to the discussions that they complement. The content itself is complete and written by many experts in the field. This is not a textbook that can, or should, be read cover to cover. The physical principles are presented clearly and can be followed by an interested reader. The physiologic principles and clinical issues will be familiar to a practitioner of cardiac medicine or imaging.

This text is by no means a beginners guide to MR imaging. It is a detailed review of the state of the art. Radiologists and cardiologists interested in MR imaging or cardiovascular imaging would find this review complete and relevant to possible applications in their practice. Anyone seriously interested in the current status of cutting edge MR imaging or interested in its performance will appreciate Coronary Magnetic Resonance Angiography. As with any new textbook, this book does not include the most recent literature citations; however, it remains authoritative and complete.

A few criticisms should be mentioned. In any textbook edited by one author and contributed to by many, one can expect a certain amount of redundancy. However, much of this redundancy was found mainly in the first few paragraphs of several of the chapters. On the other hand, one may also argue that it is not so bad to have basic principles repeated in the discussion of different clinical problems. Several figures are repeated in different chapters discussing different topics, but this repetition is rare and does not detract from the discussions at hand.

Finally, this text is coauthored by physicists, radiologists, and cardiologists. In an era of turf battles and self-righteous appeals to self-proclaimed expertise, Duerinckx has brought these experts together to produce a book that stands out as a symbol not only of how cardiovascular imaging can be practiced, but, perhaps, how it will be practiced.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Boxt, L. M. Search for Related Content PubMed Articles by Boxt, L. M. Social Bookmarking                      What's this?