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(Circulation. 2003;107:e214.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Visualization of Anomalous Coronary Artery in the Presence of Arrhythmia Using Radial Balanced Fast Field Echo Coronary Magnetic Resonance Angiography

Elmar Spuentrup, MD; Arno Buecker, MD; Matthias Stuber, PhD; Harald P. Kühl, MD

From the Department of Diagnostic Radiology (E.S., A.B.) and Medical Clinic I (H.P.K.), Technical University of Aachen, Aachen, Germany; Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass (E.S., M.S.); and Philips Medical Systems (M.S.), Best, the Netherlands.

Reprint requests to Elmar Spuentrup, MD, Department of Diagnostic Radiology, University Hospital, Technical University of Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany. E-mail spuenti{at}rad.rwth-aachen.de

A41-year-old man presented with recurrent syncope since the age of 10, along with tachyarrhythmia and angina pectoris during exercising. The patient had undergone x-ray angiography in a foreign country where a single coronary artery was seen, and he was sent to our hospital for further evaluation and therapy. Standard coronary MRA with navigator-gated free-breathing cardiac-triggered T₂-prepared 3D gradient echo imaging and cartesian k-space sampling (Figure, A; Movie I) was performed, demonstrating major motion artifacts due to tachyarrhythmia (heart frequency varying between 72 and 105 bpm [mean 92]). Thus, this standard technique did not visualize the left anterior descending coronary artery. Subsequently, navigator-gated free-breathing cardiac-triggered T₂-prepared 3D balanced fast field echo (FFE) (steady-state free precession) imaging with radial k-space sampling was performed, which allowed for clear visualization of the anomalous single coronary artery with the left coronary artery arising from the right sinus with a common ostium and an anomalous course of the left main coronary artery between the aorta and the pulmonary trunk (Figure, B). The proximal and middle portion of the left anterior descending coronary artery is clearly visible using radial balanced FFE coronary MRA (arrows in Figure, B, and Movie II), allowing for preoperative planning. Radial k-space sampling is known to be less sensitive to motion artifacts than cartesian k-space sampling.

View larger version (76K): [in this window] [in a new window]   A, Multiplanar reformats of the navigator-gated free-breathing cardiac-triggered T2-prepared 3D gradient echo coronary MRA using cartesian k-space sampling (TR=6.8 ms, TE=2.3 ms, flip angle=30°). Major cardiac motion artifacts due to tachyarrhythmia are seen (dashed arrows) abolishing sufficient visualization of the course of the anomalous single coronary artery (arrowheads in panels A and B) or the left anterior descending artery (white arrows in panels A and B). B, Multiplanar reformats of navigator-gated free-breathing cardiac-triggered T2-prepared 3D balanced FFE coronary MRA using radial k-space sampling (TR=6 ms, TE=3 ms, flip angle=120°), with identical geometric parameters and spatial resolution as used in panel A. With radial k-space sampling, only minor motion artifacts occur, and the common ostium and the course of the left main and left anterior descending artery are clearly displayed. The heart rate varied comparably between 72 and 105 bpm during both scans. Movies of the source slices as used for multiplanar reconstruction in the Figure are available in the online-only Data Supplement at http://www.circulationaha.org.

Footnotes

Movies are available in the online-only Data Supplement at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Data Supplement 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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Spuentrup, E. Articles by Kühl, H. P. Search for Related Content PubMed PubMed Citation Articles by Spuentrup, E. Articles by Kühl, H. P. Related Collections Cardiovascular imaging agents/Techniques CT and MRI