Hochauflösende 3D-MR-Koronarangiographie in
Echt-Zeit-Navigatortechnik: Ergebnisse aus
107 Patientenuntersuchungen

Zusammenfassung

Zielsetzung: Beurteilung der diagnostischen Zuverlässigkeit der hochauflösenden 3D-MR-Koronarangiographie in Echt-Zeit-Navigator-Technik an einem großen Patientenkollektiv mit Verdacht auf koronare Herzerkrankung (KHK). Methode: 107 Patienten mit Verdacht auf KHK wurden prospektiv mit einer EKG-getriggerten fettunterdrückten GE-Sequenz (Auflösung in plane 0,70 × 0,79 mm²) bei freier Atmung mit Echt-Zeit-Gating der Zwerchfellbewegung an einem 1,5 T-System (Philips, Intera) untersucht. Bei allen Patienten wurde eine konventionelle Koronarangiographie durchgeführt. Bei der Auswertung der MRT-Bilder erfolgte eine qualitative Beurteilung der Bildqualität (1: scharfe Begrenzung der Koronararterien (KA), 2: geringe Unschärfe der KA, 3: deutliche Unschärfe der KA, 4: KA nicht oder kaum abgrenzbar). Ergebnisse: Eine Bildqualität Grad 1 wurde in 24 %, Grad 2 in 48 %, Grad 3 in 24 % und Grad 4 in 4 % der Patienten erzielt. In den MR-Koronarangiographien mit diagnostischer Bildqualität (Grad 1 und 2, n = 77/107 (72 %) betrugen die Sensitivität und Spezifität im Nachweis von Koronarstenosen > 50 %, in den proximalen und mittleren Abschnitten der Hauptäste der KA 88 % bzw. 91 %. Schlussfolgerungen: 1) Die hochauflösende 3D-MR-Koronarangiographie in Echt-Zeit-Navigatortechnik ermöglicht bei selektionierten Patienten eine sehr gute Beurteilung der proximalen und mittleren Abschnitte der Koronararterienhauptäste. 2) Eine diagnostisch verwertbare Bildqualität kann allerdings nur bei 72 % der Patienten erreicht werden.

Abstract

Purpose: To evaluate the clinical value of high-resolution coronary MR angiography (coronary MRA) in a large group of patients with suspected coronary artery disease. Methods and Material: 107 patients with suspected coronary artery disease underwent free-breathing coronary MRA (Intera, 1.5 T, Philips Medical Systems). To compensate for artefacts due to respiratory motion, a right hemidiaphragmatic navigator with real time-time slice correction was used. An ECG-gated, fat-suppressed, 3D segmented-k-space gradient echo sequence (in plane resolution 0.70 × 0.79 mm²) was used. Cardiac catheterization with selective coronary angiography was performed in all patients. Visualization of the coronary arteries (CA) was qualitatively assessed using a four-point grading scale. Results: Image quality of grade 1 was achieved in 24 %, grade 2 in 48 %, grade 3 in 24 % and grade in in 4 % of patients. Based on an evaluation of the coronary MRAs of all patients (n = 107) sensitivity and specificity for the detection of stenoses > 60 % in the proximal and middle main coronary arteries were 74 % and 63 %, respectively. In coronary MRAs with good quality [grade 1 and 2, n = 77/107 (72 %)] sensitivity and specificity for the detection of coronary stenoses were 88 % and 91 %, respectively. Conclusion: Submillimeter 3D coronary MRA with real-time navigator correction allows high quality imaging of the proximal and middle main coronary arteries with good sensitivity and specificity for detection of stenoses > 50 % in selected patients. However, in abaout 28 % of patients image quality is severely impaired.

Magnetresonanztomographie - MR-Angiographie - Koronararterien - Koronare Herzerkrankung

Magnetic resonance (MR) - Vascular studies - coronary vessels - MR - coronary vessels - Diseases - magnetic resonance - Three-dimensional

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