Coronary Magnetic Resonance Angiography
Andre J. Duerinckx
342 pp. New York, NY: Springer-Verlag; 2002. $198.00. ISBN 0-387-94959-3
Recent advances in MRI hardware and software permit the routine acquisition of images of the coronary arterial lumen at a field strength of 1.5 tesla. Within the past 10 years, investigators from many countries have documented the usefulness of MRI techniques in identifying the course of normal and anomalous coronary arteries, determining native coronary artery and bypass graft patency, and measuring coronary arterial blood flow reserve. Importantly, these advances have been achieved noninvasively without exposure to ionizing radiation or iodinated contrast materials. In addition, these new coronary imaging and flow assessment techniques can be combined in a single examination with other cardiac MRI procedures, such as assessments of left ventricular structure and function, myocardial perfusion, or metabolism.
At present, many of these advances are confined to academic medical centers or highly specialized clinical imaging centers. The reduced availability of educational materials has contributed to the limited use of these new MRI techniques in clinical practice. In his text entitled Coronary Magnetic Resonance Angiography, Andre Duerinckx seeks to overcome this limitation by providing readers with material collected from investigators throughout the world that have contributed to the development of coronary arterial MRI.
The first 5 chapters of his textbook address the fundamentals (physics and pulse sequences) of performing MRI exams of the coronary arteries. Chapters 5 through 7 review the slice positions (2-dimensional and 3-dimensional) used to acquire coronary artery images. Chapters 8 and 9 review the effectiveness of MRI techniques for detecting anomalous coronary arteries in otherwise healthy individuals and in patients with congenital heart disease. Chapters 10 and 11 discuss MRI techniques for identifying coronary arterial bypass grafts. Chapters 12 through 14 address the ability of MRI techniques to detect flow-limiting coronary arterial luminal narrowings. Emphasis is placed on imaging the coronary arterial lumen and on functional assessments, such as measures of coronary arterial blood flow reserve. Chapters 15 through 26 address many of the difficulties encountered when imaging coronary arteries. Alternatives for overcoming these limitations including the implementation of contrast agents, navigator pulse sequences, post-processing strategies, and advanced pulse sequences using 2 or 3-dimensional imaging strategies are discussed. Lastly, in chapters 26 through 32, a brief mention is made of other cardiovascular MRI applications, including stress perfusion and function exams.
Highlights of this text include the facts that the writing style enables beginning or advanced technologists or physicians to understand the material presented, the text is well referenced and results from clinical trials are summarized in tabular form, the chapters regarding anomalous coronary arteries are particularly informative, and substantial information is presented for resolving artifacts encountered when performing coronary arterial MRI.
The text has a few limitations. First, although the slice positioning strategies for the right coronary artery and bypass grafts are well outlined, there is less description for the left coronary arterial circulation. Second, little information is presented about the acquisition of images of the coronary arterial wall or characterization coronary plaques. Third, pitfalls for interpreting angiograms and making absolute or phasic flow measurements are not discussed in great detail. Finally, interventional coronary MRI techniques are not discussed.
As manufacturers and investigators expand the efficacy and availability of MRI for performing coronary arterial imaging, the use of this technology for assisting in the management of patients with coronary arteriosclerotic disease may become more prevalent. Texts such as this that organize the work of many investigators should improve the ability of physicians and technicians to utilize cardiovascular MRI for coronary angiography.