Cardiac magnetic resonance imaging in patients with coronary disease |
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Authors: | Henry D Wu Raymond Y Kwong |
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Institution: | (1) Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA |
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Abstract: | Opinion statement Cardiac magnetic resonance (CMR) has emerged as a versatile noninvasive tool for the comprehensive evaluation of patients
with suspected or established coronary artery disease (CAD). In a single imaging session, CMR can assess left ventricular
anatomy and function, myocardial perfusion, viability, and coronary luminal stenosis. Using specific pulse sequences, left
ventricular global and regional function can be assessed by cine CMR at rest and in response to inotropic stress; first-pass
perfusion quantified by vasodilator stress; myocardial viability evaluated by delayed enhancement imaging and also by functional
reserve; and coronary artery stenosis assessed by angiography. All these modalities can be achieved with high spatial resolution
and image contrast, without exposure to ionizing radiation, and within a reasonable time frame of about 1 hour of scan time.
Also, the imaging planes can be programmed to provide identical views of the heart for each type of image, thereby facilitating
intermodality comparisons. There is early but accumulating evidence that the accuracy and prognostic values of many of these
modalities are comparable or superior to radionuclide scintigraphy and echocardiography in head-to-head studies. Current limitations
unique to CMR include the inability to perform exercise stress testing inside the CMR suite and exclusion of patients with
indwelling metallic devices such as defibrillators and pacemakers. Despite these limitations, CMR is unique in its multifaceted
approach that can be specifically tailored to the clinical question at hand, making it arguably the best tool for the diagnosis
and management of CAD. With the rapid pace of advancement in CMR hardware and pulse sequence technologies, the clinical use
of this powerful technique is likely to grow even greater in this area. |
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