European Journal of Radiology 38 (2001) 191 – 199 Magnetic resonance imaging in coronary heart disease Valentin Sinitsyn * Department of Tomography, Cardiology Research Center, 3d Cherepkoskaya Street 15a, 121552 Moscow, Russia Received 26 January 2001; accepted 29 January 2001 Abstract Modern level of cardiac magnetic resonance imaging (MRI) development already allows its routine use (with proper indications) in coronary heart disease patients for studies of heart morphology and functions, performance of stress tests for evaluation of myocardial perfusion and contractile function. Coronary MRA and some other new MR techniques are close to its wide-scale clinical application. It has been shown that cardiac MRI is a valuable tool for detection of postinfarction scars, aneurysms, pseudoaneurysms, septal defects, mural thrombi and valvular regurgitations. Due to intrinsic advantages of the method it is of special value when these pathological conditions cannot be fully confirmed or excluded with echocardiography. MRI is recognized as the best imaging method for quantification of myocardial thickness, myocardial mass, systolic myocardial thickening, chamber volumes, ejection fraction and other parameters of global and regional systolic and diastolic function. MRI is used in studies of cardiac remodeling in postinfarction patients. The most attractive areas for cardiovascular applications of MRI are assessment of myocardial perfusion and non-invasive coronary angiography. Substantial progress has been achieved in these directions. There are some other new developments in studies of coronary artery disease with MRI. High-resolution MR is used for imaging and quantification of atherosclerotic plaque composition in vivo. Intravascular MR devices suitable for performing imaging-guided balloon angioplasty are created. But before MRI will be widely accepted by the medical community as a important cardiovascular imaging modality several important problems have to be solved. Further technical advances are necessary for clinical implementation of all major diagnostic capabilities of cardiac MRI. The subjective obstacles for growth of clinical applications of cardiac MRI are lack of understanding of its possibilities and benefits both by clinicians and radiologists themselves. So proper training of specialists and promotion of this promising modality among the medical community are necessary. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Radiology; Cardiology; Magnetic resonance imaging; Heart; Ischemia; Coronary artery; Angiography; Myocardial perfusion www.elsevier.nl/locate/ejrad 1. Introduction Modern imaging technologies make a major contri- bution to diagnosis of coronary heart disease and its complications [1]. Coronary angiography, radionuclide imaging and echocardiography provide most of the information necessary for the cardiologist and cardio- vascular surgeon for assessment of patient with coro- nary artery disease. Cardiovascular magnetic resonance imaging (MRI) has been used for the evaluation of the heart for a long period (since the early 1980s). We have witnessed great technical improvements in the modality [2,3]. The first conventional pulse sequences for cardiac MRI were spin-echo and gradient-echo techniques. De- velopment of faster and stronger gradient systems, new types of radiofrequency coils, fast 2D or 3D gradient echo, echo-planar, spiral and parallel imaging se- quences in combination with contrast agents resulted in dramatic changes in diagnostic possibilities of the modality. Increased time and spatial resolution, better signal-to-noise ratio, decreased respiratory and cardiac motion artifacts made MRI a true functional and flex- ible imaging modality. In most cases MRI is used as an additional noninva- sive diagnostic method when data of echocardiography are incomplete or need confirmation. It is known that hearts of about 15 – 25% patients cannot be completely examined by transthoracic echocardiography. In this patient group, MRI can be used as a second-line non- invasive technique to provide important diagnostic in- formation not obtainable by echocardiography. But in * Tel.: +7-95-4146334; fax: +7-95-4146699. E-mail address: vsin@online.ru (V. Sinitsyn). 0720-048X/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0720-048X(01)00307-2