Ist die koronare Magnetresonanzangiographie als diagnostisches Routineverfahren schon zu empfehlen?

Zusammenfassung

Die Magnetresonanztomographie (MRT) bietet die Möglichkeit, die Koronararterien nichtinvasiv und ohne den Einsatz ionisierender Strahlung darzustellen. Aufgrund des geringen Durchmessers, des kurvenreichen Verlaufes und der starken Bewegung der Koronararterien sowie der Signalüberlagerung von umgebendem Fett und Myokard ist die koronare Magnetresonanzangiographie (MRA) technisch anspruchsvoll. Im Vergleich zur invasiven katheterbasierten Koronarangiographie können derzeit nicht alle Gefäßabschnitte untersucht werden, und in den auswertbaren Abschnitten ist die Genauigkeit zur Erkennung von Stenosen noch suboptimal. Allerdings lässt sich das Vorhandensein von Koronaranomalien sowie die Durchgängigkeit von aortokoronaren Bypasses mit der MRA gut beurteilen. Die Kombination der koronaren MRA mit MRT-Protokollen zur Ischämiediagnostik hat das Potential, ein klinisch wertvolles Instrument für die Diagnostik der koronaren Herzkrankheit zu werden.

Summary

Magnetic resonance imaging (MRI) allows the evaluation of coronary arteries non-invasively and without the use of ionizing radiation. Coronary magnetic resonance angiography (MRA) is technically demanding due to the small size, tortuous course, and bulk motion of the coronary arteries as well as signal from surrounding epicardial fat and myocardium. In comparison to invasive x-ray coronary angiography not all coronary artery segments can be assessed by coronary MRA. At present the diagnostic accuracy of coronary MRA for detection of significant stenosis in coronary arteries is suboptimal. The presence of coronary anomalies and the patency of aortocoronary bypass grafts can be assessed by MRA with high diagnostic accuracy. The combination of coronary MRA with other MRI techniques for detection of ischemia has the potential to be of clinical value in the diagnostic work-up of patients with coronary artery disease.

Literatur

• 1 Al-Saadi N, Nagel E, Gross M. et al . Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance.  Circulation. 2000;  101 1379-1383
• 2 Botnar R M, Stuber M, Danias P G. et al . Improved coronary artery definition with T2-weighted, free breathing, three-dimensional coronary MRA.  Circulation. 1999;  99 3139-3148
• 3 Bunce N H, Jhooti P, Keegan J. et al . Evaluation of free-breathing three dimensional magnetic resonance coronary angiography with hybrid ordered phase encoding (HOPE) for the detection of proximal coronary artery stenosis.  J Magn Reson Imaging. 2001;  14 677-684
• 4 Barkhausen J, Hunold P, Jochims M. et al . Vergleich von Gradienten-Echo und steady state free precession Sequenzen zur 3D-Navigator-MR-Koronarangiographie.  Fortschr Röntgenstr. 2002;  174 725-730
• 5 Dewey M, Taupitz M. Coronary angiography by magnetic resonance imaging and computed tomography.  Dtsch Med Wochenschr. 2003;  128 33-35
• 6 Dodge J T, Brown B G, Bolson H T, Dodge H T. Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation and left ventricular hyperthrophy or dilation.  Circulation. 1992;  86 232-246
• 7 Duerinckx A J, Urman M K. Two-dimensional coronary MR angiography: analysis of initial clinical results.  Radiology. 1994;  193 731-738
• 8 European Cardiovascular Disease Statistics 2000 Edition. British Heart Foundation Homepage. 14.6.2004 2004
• 9 Edelmann R R, Manning W J, Burstein D, Paulin S. Coronary arteries: breath-hold MR angiography.  Radiology. 1991;  181 641-643
• 10 Greil G F, Stuber M, Botnar R M. et al . Coronary magnetic resonance angiography in adolescents and young adults with kawasaki disease.  Circulation. 2002;  105 908-911
• 11 Huber M E, Paetsch I, Schnackenburg B. et al . Performance of a new gadolinium-based intravascular contrast agent in free-breathing inversion-recovery 3D coronary MRA.  Magn Reson Med. 2003;  49 115-121
• 12 Hug J, Nagel E, Bornstedt A. et al . Coronary arterial stents: Safety and artifacts during MR imaging.  Radiology. 2000;  216 781-787
• 13 Hundley W G, Hamilton C A, Clarke G D. et al . Visualization and functional assessment of proximal and middle left anterior descending coronary stenoses in humans with magnetic resonance imaging.  Circulation. 1999;  99 3248-3254
• 14 Hunold P, Vogt F M, Schmermund A. et al . Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT.  Radiology. 2003;  226 145-152
• 15 Jara H, Yu B C, Caruthers S D. et al . Voxel sensitivity function description of flow-induced signal loss in MR imaging: Implications for black-blood MR angiography with spin-echo sequences.  Magn Reson Med. 1999;  41 575-590
• 16 Kaul M G, Stork A, Bansmann P M. et al . Evaluation of Balanced Steady-State Free Precession (TrueFISP) and K-space Segmented Gradient Echo Sequences for 3D Coronary MR Angiography with Navigator Gating at 3 Tesla.  Rofo. 2004;  176 1560-1565
• 17 Kessler W, Achenbach S, Moshage W. et al . Beurteilung von Koronararterienstenosen mittels atemkontrollierter NMR-Angiographie.  Z Kardiol. 1998;  87 119-127
• 18 Kim R J, Fieno D S, Parrish T B. et al . Relationship of MRI Delayed Enhancement to Irreversible Injury, Infarct Age, and Contractile Function.  Circulation. 1999;  100 1992-2002
• 19 Kim W Y, Stuber M, Börnert P. et al . Three-Dimensional Black-Blood Cardiac Magnetic Resonance Coronary Vessel Wall Imaging Detects Positive Arterial Remodeling in Patients With Nonsignificant Coronary Artery Disease.  Circulation. 2002;  106 296-299
• 20 Kim W Y, Danias P, Stuber M. et al . Coronary magnetic resonance angiography for the detection of coronary stenosis.  N Engl J Med. 2001;  345 1863-1869
• 21 Langerak S E, Vliegen H W, de Roos A. et al . Detection of Vein Graft Disease Using High-Resolution Magnetic Resonance Angiography.  Circulation. 2002;  105 328-333
• 22 Langerak S E, Vliegen H W, Jukema J W. et al . Value of Magnetic Resonance Imaging for the Noninvasive Detection of Stenosis in Coronary Artery Bypass Grafts and Recipient Coronary Arteries.  Circulation. 2003;  107 1502
• 23 Laskey W K, Kimmel S, Krone R J. Contemporary trends in coronary intervention: A report from the registry of the society for cardiac angiography and interventions.  Cathet Cardiovasc Intervent. 2000;  49 19-22
• 24 Lethimonnier F, Furber A, Morel O. et al . Three-dimensional coronary artery MR imaging using prospective real-time respiratory navigator and linear phase shift processing: Comparison with conventional coronary angiography.  Magnetic Resonance Imaging. 1999;  17 1111-1120
• 25 Li D, Paschal C B, Haacke E M, Adler L P. Coronary arteries: three-dimensional MR imaging with fat saturation and magnetization transfer contrast.  Radiology. 1993;  187 401-406S>
• 26 McConnell M V, Ganz P, Selwyn A P. et al . Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography.  Circulation. 1995;  92 3158-3162
• 27 Manning W J, Wei L i, Edelmann R R. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography.  N Engl J Med. 1993;  328 828-832
• 28 Muller M F, Fleisch M, Kroeker R. et al . Proximal coronary artery stenosis: three-dimensional MRI with fat saturation and navigator echo.  J Magn Reson Imaging. 1997;  7 644-651
• 29 Moustapha A I, Pereyra M, Muthupillai R. et al . Coronary magnetic resonance angiography using a free-breathing, T2 weighted, three-dimensional gradient echo sequence with navigator respiratory and ECG gating can be used to detect coronary artery disease.  J Am Coll Cardiol. 2001;  37 380A
• 30 Morin R L, Gerber T C, McCollough C H. Radiation Dose in Computed Tomography of the Heart.  Circulation. 2003;  107 917-922
• 31 Nagel E, Lehmkuhl H B, Bocksch W. et al . Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography.  Circulation. 1999;  99 763-770
• 32 Nagel E, Thouet T, Klein C. et al . Noninvasive determination of coronary blood flow velocity with cardiovascular magnetic resonance in patients after stent deployment.  Circulation. 2003;  107 1738-1743
• 33 Nieman K, Cademartiri F, Lemos P A. et al . Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.  Circulation. 2002;  106 2051-2054
• 34 Pennell D J, Bogren H G, Keegan J. et al . Assessment of coronary artery stenosis by magnetic resonance imaging.  Heart. 1996;  75 127-133
• 35 Post J C, van Rossum A C, Bronzwaer J G. et al . Magnetic resonance angiography of anomalous coronary arteries: a new gold standard for delineating the proximal course?.  Circulation. 1995;  92 3163-3171
• 36 Post J C, van Rossum A C, Hofman M B. et al . Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography.  Am J Roentgenol. 1996;  166 1399-1404
• 37 Post J C, van Rossum A C, Hofman M B. et al . Clinical utility of two-dimensional magnetic resonance angiography in detecting coronary artery disease.  Eur Heart J. 1997;  18 426-433
• 38 Pruessmann K P, Weiger M, Scheidegger M B. et al . SENSE: Sensitivity encoding for fast MRI.  Magn Reson Med. 1999;  42 952-962
• 39 Regenfus M, Ropers D, Achenbach S. et al . Noninvasive detection of coronary artery stenosis using contrast-enhanced three-dimensional breath-hold magnetic resonance coronary angiography.  J Am Coll Cardiol. 2000;  36 44-50
• 40 Ricciardi M J, Wu E, Davidson C J. et al . Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation.  Circulation. 2001;  103 2780-2783
• 41 Rogers W J, Shapiro E P, Weiss J L. et al . Quantification of and correction for left ventricular systolic long- axis shortening by magnetic resonance tissue tagging and slice isolation.  Circulation. 1991;  84 721-731
• 42 Ropers D, Baum U, Pohle K. et al . Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.  Circulation. 2003;  107 664-666
• 43 Sandstede J J, Pabst T, Beer M. et al . Three-dimensional MR coronary angiography using the navigator technique compared with conventional coronary angiography.  Am J Roentgenol. 1999;  172 135-139
• 44 Sardanelli F, Molinari G, Zandrino F. et al . Three-dimensional navigator-echo MR coronary angiography in detecting stenoses of the major epicardial vessels, with conventional coronary angiography as the standard of reference.  Radiology. 2000;  214 808-814
• 45 Scanlon P J, Faxon D P, Audet A M. et al . ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association task force on Practice Guidelines (Committee on Coronary Angiography).  J Am Coll Cardiol. 1999;  33 1756-1782
• 46 Silber S, Albrecht A, Gohring S. et al . First annual report of practitioners of interventional cardiology in private practice in Germany. Results of producers of left heart catheterization and coronary interventions in the year 1996.  Herz. 1998;  23 47-57
• 47 Spuentrup E, Botnar R M, Lanzer P. Technische Aspekte der MR-Koronarangiographie.  Z Kardiol. 2002;  91 107-124
• 48 Stuber M, Botnar R M, Danias P G. et al . Contrast agent-enhanced, free-breathing, three-dimensional coronary magnetic resonance angiography.  J Magn Reson Imaging. 1999;  10 790-799
• 49 Stuber M, Botnar R M, Kissinger K V, Manning W J. Free-breathing black-blood coronary MR angiography: initial results.  Radiology. 2001;  219 278-283
• 50 Stuber M, Botnar R M, Fischer S E. et al . Preliminary report on in vivo coronary MRA at 3 Tesla in humans.  J Magn Reson Med. 2002;  48 425-429
• 51 van Geuns R JM, de Bruin H G, Rensing B JWM. et al . Magnetic resonance imaging of the coronary arteries: clinical results from three dimensional evaluation of a respiratory gated technique.  Heart. 1999;  82 515-519
• 52 van Geuns R JM, Wielopolski P A, de Bruin H G. et al . MR coronary angiography with breath-hold targeted volumes: Preliminary clinical results.  Radiology. 2000;  217 270-277
• 53 Vrachliotis T G, Bis K G, Aliabadi D. et al . Contrast-enhanced breath-hold MR angiography for evaluating patency of coronary artery bypass grafts.  Am J Roentgenol. 1997;  168 1073-1080
• 54 Wagner A, Mahrholdt H, Holly T A. et al . Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study.  Lancet. 2003;  361 374-379
• 55 Watanuki A, Yoshino H, Udagawa H. et al . Quantitative evaluation of coronary stenosis by coronary magnetic resonance angiography.  Heart Vessels. 2000;  15 159-166
• 56 Watanabe Y, Nagayama M, Amoh Y. et al . High-sesolution selective three-dimensional magnetic resonance coronary angiography with navigator-echo technique: Segment-by-segment evaluation of coronary artery stenosis.  J Magn Reson Imaging. 2002;  16 238-245
• 57 Wintersperger B J, Engelmann M G, von Smekal A. et al . Patency of coronary bypass grafts: assessment with breath-hold contrast-enhanced MR-angiography - value of a non-electrocardiographically triggered technique.  Radiology. 1998;  208 345-351
• 58 Woodard P K, Li D, Haacke E M. et al . Detection of coronary stenoses on source and projection images using three-dimensional MR angiography with retrospective respiratory gating: preliminary experience.  Am J Roentgenol. 1998;  170 883-888
• 59 Yucel E K, Anderson C M, Edelman R R. et al . AHA scientific statement. Magnetic resonance angiography: update on applications for extracranial arteries.  Circulation. 1999;  100 2284-2301
• 60 FDA. homepage at http://www.fda.gov/cdrh/safety/mrisafety.html. 14.06.2004 2004