(Circulation. 2000;102:2582.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive Coronary Vessel Wall and Plaque Imaging With Magnetic Resonance Imaging
From the Department of Medicine, Cardiovascular Division (R.M.B., M.S., K.V.K., W.Y.K., E.S., W.J.M.) and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass, and Philips Medical Systems (R.M.B., M.S.), Best, The Netherlands.
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Abstract |
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 Top Abstract IntroductionMethodsResultsDiscussionAppendix 1References |
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Background—Conventional x-ray angiography frequently underestimates the true burden of atherosclerosis. Although intravascular ultrasound allows for imaging of coronary plaque, this invasive technique is inappropriate for screening or serial examinations. We therefore sought to develop a noninvasive free-breathing MR technique for coronary vessel wall imaging. We hypothesized that such an approach would allow for in vivo imaging of coronary atherosclerosis.
Methods and Results—Ten subjects, including 5 healthy adult volunteers (aged 35±17 years, range 19 to 56 years) and 5 patients (aged 60±4 years, range 56 to 66 years) with x-ray–confirmed coronary artery disease (CAD), were studied with a T2-weighted, dual-inversion, fast spin-echo MR sequence. Multiple adjacent 5-mm cross-sectional images of the proximal right coronary artery were obtained with an in-plane resolution of 0.5x1.0 mm. A right hemidiaphragmatic navigator was used to facilitate free-breathing MR acquisition. Coronary vessel wall images were readily acquired in all subjects. Both coronary vessel wall thickness (1.5±0.2 versus 1.0±0.2 mm) and wall area (21.2±3.1 versus 13.7±4.2 mm2) were greater in patients with CAD (both P<0.02 versus healthy adults).
Conclusions—In vivo free-breathing coronary vessel wall and plaque imaging with MR has been successfully implemented in humans. Coronary wall thickness and wall area were significantly greater in patients with angiographic CAD. The presented technique may have potential applications in patients with known or suspected atherosclerotic CAD or for serial evaluation after pharmacological intervention.
Key Words: vessels • plaque • magnetic resonance imaging • atherosclerosis
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Introduction |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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Conventional coronary angiography frequently underestimates the true burden of atherosclerosis. As reported by Glagov et al,1 the initial response to endothelial injury and development of atherosclerosis is vessel enlargement, with relative preservation of lumen diameter. Subsequent plaque progression, with lumen-encroachment stenoses, is a later event. Invasive x-ray coronary angiography and bright-blood2 3 coronary magnetic resonance angiography (MRA) only allow for assessment of luminal vessel diameter and do not provide direct information regarding coronary vessel wall thickness or atherosclerotic plaque. Recent intravascular ultrasound (IVUS) studies4 5 have shown that lesion-site cross-sectional area, minimum lesion diameter, cross-sectional narrowing, and area stenosis are good predictors for subsequent acute cardiac events. However, this invasive technique is not appropriate for screening or serial examinations. Apart from plaque burden and luminal encroachment, plaque composition is a predictor of plaque vulnerability. Lipid-rich plaques with thin fibrous caps are often associated with acute coronary events, not only because of their greater vulnerability to rupture, but also because of enhanced thrombogenicity after rupture.6 A noninvasive technique that would allow for visualization of plaque area and luminal vessel area narrowing and that also allowed for characterization of the plaque constituents would therefore be of great interest.
Noninvasive MR coronary vessel wall and plaque imaging is particularly challenging owing to cardiac and respiratory motion, small coronary vessel wall thickness, and low contrast-to-noise ratios (CNRs) between the coronary vessel wall and the surrounding epicardial fat, coronary blood, and myocardium. Because bulk cardiac motion during the respiratory cycle may exceed a multiple of the coronary wall thickness, accurate respiratory motion compensation is critical for coronary vessel wall imaging and has been successfully applied for bright-blood coronary MRA.7 Because of intrinsic bulk cardiac motion, coronary artery imaging is best achieved during end systole or mid diastole, a short time period (<100 ms) of relative myocardial diastases.8 9 T2-weighted black-blood fast spin-echo (TSE) techniques have been successfully applied for aortic10 and carotid11 vessel wall imaging. However, signal from slow-flowing blood in the laminar boundary layer adjacent to the vessel wall may mimic vessel wall signal and cause an overestimation of wall thickness/area. This situation can be minimized by the use of a double-inversion prepulse (dual IR), which depends on blood exchange instead of spin dephasing. Because of the long T1 of blood and the need to image close to the zero crossing of its longitudinal magnetization, the resultant inversion delay only allows for diastolic image acquisition.
Recently, preliminary results of coronary MR plaque imaging with breathhold (BH) approaches have been reported.12 13 14 15 BH strategies, however, are often difficult to implement in patients, especially those with coronary artery or pulmonary disease. We sought to develop a noninvasive, free-breathing coronary vessel wall imaging approach using a dual IR TSE sequence and to compare coronary vessel wall and lumen area in healthy and diseased subjects. In this article, we discuss the given boundary conditions, present possible solutions, and show first in vivo results. We hypothesize that this technique might also have potential for noninvasive in vivo imaging of coronary plaque.
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Methods |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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Subjects
Ten subjects, including 5 healthy adult subjects (aged 35±17 years, range 19 to 56 years) without history of coronary artery disease (CAD) and 5 patients (60±4 years, range 56 to 66 years) with x-ray–confirmed CAD, were examined in the supine position with a 5-element cardiac synergy coil for signal reception. For cardiac synchronization, 3 electrodes were placed on the left anterior hemithorax, and scans were triggered on the R wave of the ECG. All examinations were done during uncoached free breathing by use of a Philips Gyroscan NT MR system (Philips Medical Systems) equipped with PowerTrak 6000 gradients and an advanced cardiac software patch (CPR6). Written informed consent was obtained from all participants.
Imaging Sequence
Localization of the RCA
A rapid, ECG-triggered multislice, multistack,
segmented gradient echo scan allowed for localization of the heart in 3
(transverse, coronal, and sagittal) orthogonal planes (TR=8 ms, TE=2
ms, shots=2, flip angle=30°, slice thickness=3 mm, field of
view=180x180 mm, matrix=256x64). For subsequent planning of
cross-sectional views of the right coronary artery (RCA) a fast,
navigator-gated16
and
-corrected17 18
transverse 3D turbo field echo (TFE)/echo planar imaging (EPI)
scan19 that allowed
for identification of the RCA was planned on a coronal view of the
first scout scan. The navigator was placed on the dome of the right
hemidiaphragm, and all subsequent scanning was performed with a 5-mm
gating window and a constant superior-inferior correction factor
(0.6).20 A 3-point
plan-scan tool19 was
used to prescribe an imaging plane along the major axis of the RCA.
This plane was used in a subsequent 3D TFE/EPI scout
scan21 of the RCA
(Figure 1
) that allowed for display of the RCA in-plane.
Navigator parameters were maintained for all subsequent imaging
sequences.
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Coronary Vessel Wall Imaging
With a coronary scout scan that depicted the proximal
RCA
(Figure 1
), a free-breathing 2D dual IR TSE scan was planned
orthogonal to the proximal RCA. This imaging sequence can be divided
into 4 sequence blocks
(Figure 2).
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Dual IR
Immediately after detection of the R wave of
the ECG, a dual IR
prepulse22 23
was applied. This consisted of a nonselective, followed by a
slice-selective, 180° radiofrequency pulse. Slice thickness (12.5 mm)
of the labeled slice was 2.5 times the thickness of the imaged slice.
The TR-dependent inversion delay with respect to the TSE imaging
sequence was given by the zero crossing
time24 of the
longitudinal magnetization of blood and allowed for middiastolic image
acquisition, a time period of relative cardiac
diastasis.8 9
 | (1) |
MR Navigator
Shortly before the 2D TSE image acquisition block, a
2D selective real-time navigator was applied for respiratory gating and
real-time slice-position
correction.17 18
Total navigator duration for excitation and real-time correction was 35
ms.
TSE Image Acquisition
To suppress signal from epicardial fat, a
frequency-selective small-banded radiofrequency pulse (15 ms) was
applied immediately before the imaging portion of the sequence.
Middiastolic imaging was performed with a 2D
T2-weighted11 25
TSE sequence with a linear profile order, echo train length of 7 to 9,
echo spacing (ESP) of 
5.7 ms, and 5-mm slice thickness. The
effective echo time (eTE) was set to 25 ms to maximize signal from the
vessel wall (Appendix). The resulting acquisition window was 50 ms. A
repetition time (TRR) of 2 heartbeats and 4
signal averages were used. With a field of view of 260x208 mm and an
image matrix of 512x204, in-plane spatial resolution was 0.5x1.0 mm.
Phase-encoding direction was parallel to the chest wall to minimize
respiratory motion artifacts.
SNR and CNR Measurements
We determined signal-to-noise ratio (SNR) of the RCA
wall by manually segmenting the wall area and calculating the mean
signal (S). Noise (N) was determined within a region of interest drawn
in front of the chest wall. CNR
[(Swall-SI)/N]
was measured between vessel wall and epicardial fat
(Sfat) and coronary blood
(Sblood). The index I stands for fat and
coronary blood, respectively.
Lumen and Vessel Wall Area Measurements
To minimize angulation errors due to the initial
curvature of the RCA, we imaged 2 to 3 cm distal to the origin in a
relatively linear portion of the RCA. In patients with CAD, vessel wall
scans were preferably performed proximal, within, and distal to the
stenosis/occlusion. On magnified cross-sectional images of the RCA, the
inner lumen and outer vessel borders were then manually segmented to
determine lumen (inner area) and wall area (vessel area minus
lumen). Average lumen diameter and wall thickness was calculated
assuming a circular vessel shape.
 | (2) |
Statistics
Data analysis was performed by 2 blinded observers
(W.Y.K., E.S.), and data are expressed as mean±SD. Continuous
variables were compared with a 2-tailed unpaired Student’s
t test, with significance as
P
0.05.
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Results |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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The total examination time was
20 minutes, with an
average scanning time for each 2D slice of 4.5 (90 bpm) to 6.8 (60
bpm) minutes (with navigator efficiency of 50%). In all subjects, the
RCA wall was successfully visualized with definition from surrounding
epicardial fat and coronary blood
(Figure 3) with suppression of blood signal using the dual IR
prepulse and middiastolic image acquisition. No artifacts from in-plane
blood flow in the ventricles were observed.
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Vessel Wall Thickness
Among healthy subjects, wall thickness (including
adventitia) was 1.0±0.2 mm, with lumen diameter of 3.4±0.4 mm, wall
area of 13.7±4.2 mm2, and lumen area of
9.3±1.9 mm2. Mean vessel wall thickness was
higher in CAD patients (1.5±0.2 mm; P<0.004 versus
healthy subjects). Similarly, mean wall area was also increased
(21.2±3.1 mm2, P<0.02).
There was also a trend toward a reduced lumen area in patients with CAD
(7.0±2.3 versus 9.3±1.9 mm; P<0.14). All vessel
wall and lumen measurements were done in the proximal RCA (30±7 mm,
range 22 to 36 mm versus 29±4 mm, range 24 to 33 mm in patients with
CAD; P=NS) and always proximal to the stenosis in
patients with CAD.
SNR and CNR
Average SNR of the RCA wall was 18±6. CNRs between RCA
wall/epicardial fat and RCA wall/coronary blood were 9±1, and 9±4,
respectively.
Coronary Wall Images
In healthy adult subjects
(Figure 3), the RCA wall was primarily circular, with
homogeneous signal distribution within the wall. The ratio of lumen
diameter to wall thickness was 3.5 to 1.
Visualization of the proximal, mid, and distal RCA wall in a
patient with occlusive mid-RCA disease
(Figure 4) demonstrated a dark lumen surrounded by a bright
circular wall proximal and distal to the lesion. In the mid RCA, no
lumen was visible at the site of a total (100%) occlusion
(Figure 4). In another patient with a tubular stenosis in the
proximal and mid RCA on x-ray angiogram and coronary MRA, the RCA wall
was eccentrically thickened, suggestive of a focal atherosclerotic
plaque
(Figure 5). Another patient with occlusive disease of the mid
RCA
(Figure 6) revealed a dark lumen surrounded by a circular
thickened wall in the proximal RCA and a smaller, bright circular
signal area with no readily visible lumen in the mid RCA, suggestive of
an occlusion.
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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In this study, we demonstrate the ability to obtain in vivo free-breathing coronary MR vessel wall and plaque images in humans. Such an advance offers the potential opportunity to identify coronary atherosclerosis before the development of flow-limiting luminal stenoses.
Coronary Wall Images
MR estimates of coronary lumen diameter and lumen area
compare favorably with historical IVUS
data,4 but MR values
overestimate historical IVUS coronary wall thickness and wall
area.4 The MR
overestimation may be explained by the lower in-plane (500x1000 versus
100x100 µm) and through-plane spatial resolution (5 versus 0.15 mm)
compared with IVUS. This would lead to partial volume effects resulting
in an overestimation of the true vessel wall area and thickness.
Furthermore, residual respiratory or cardiac motion may cause image
blurring, thereby leading to an overestimation of the true vessel wall
area. Incomplete flow exchange of slow-flowing blood might mimic signal
from the vessel wall, thereby causing an additional overestimation of
the true vessel wall thickness, but this effect is expected to be
small, because the dual IR prepulse was optimized for minimization of
blood signal. Compared with MRI, IVUS vessel wall measurements do not
include the adventitia, which might also contribute to the larger
coronary vessel wall areas as measured by MRI.
Coronary wall thickness and wall area were significantly greater in patients with CAD than in healthy adult subjects. There was also a trend toward a reduced lumen area in patients with CAD. Although we suspect the wall thickening is due to atherosclerosis, we cannot fully exclude the impact of the age difference between the 2 groups. The positive correlation between x-ray–confirmed CAD and MR-based measurements of coronary wall thickness suggests that MR coronary vessel wall imaging is able to assess coronary vessel wall thickening in vivo. Additionally, MR vessel wall imaging allowed assessment of x-ray–confirmed occlusive CAD. The bright signal at the location of the suspected stenosis may be the result of slow-flowing blood or may be from a lumen-narrowing plaque and/or a plaque overlaid by a thrombus.
Signal-to-Noise Values
The relatively high SNR values of the MR RCA wall data
demonstrate that there is a potential to further increase spatial
resolution. 3D approaches might be another alternative to facilitate
higher spatial resolution, but this remains to be explored. CNR
measurements between the RCA wall and epicardial fat and coronary blood
demonstrate the good delineation of the RCA wall from the surrounding
tissues, primarily epicardial fat. Average signal of ventricular blood
was similar to the noise level, demonstrating the desired impact of the
dual IR prepulse.
Dual IR Prepulse
The use of a dual IR for black-blood imaging in the
heart seems to be crucial to minimize signal from slow-flowing blood
and artifacts from incomplete spin dephasing, as are often seen in
conventional TSE techniques. However, longer echo times, which would
increase spin dephasing and eventually lead to a complete nulling of
the blood signal, are not suited for coronary vessel wall imaging
because (1) measurements with long acquisition window durations (>100
ms) are prone to artifacts due to cardiac motion and (2) the optimal TE
for wall imaging is 25 ms (Appendix). Additionally, incomplete spin
dephasing due to slow-flowing blood in the boundary layer may mimic
signal that is similar to the vessel wall, thus leading to an
overestimation of the coronary wall thickness. Compared with a
conventional TSE technique, black-blood properties of the dual IR
prepulse only rely on blood exchange, which is expected to be
sufficient within the relatively long inversion time period of 500
to 600 ms.
Navigator
The use of a 2D selective navigator for respiratory
motion compensation allows removal of the constraints of a BH and
thereby enables free-breathing coronary vessel wall imaging. Compared
with BH techniques that rely on rapid image acquisition, navigator
techniques allow for a broader range of echo trains and TE, thus
providing greater flexibility in choosing the optimal contrast between
vessel wall, lipids, and epicardial fat. This flexibility can be used
to optimize contrast for best vessel delineation or best
differentiation between the different plaque constituents. The good
delineation of the RCA wall
(Figure 3), a structure of <1 mm, also demonstrates that
navigator gating and real-time tracking in concert with a dual IR
prepulse are effective. Because labeling with the dual IR prepulse is
performed during end diastole and imaging is performed during mid
diastole, matching of the labeled and imaged slice is not trivial. It
can, however, be facilitated by increasing the slice thickness of the
labeled slice to a multiple (2.5) of the thickness of the imaged
slice.
Cardiac Motion and Acquisition Window
In addition to bulk motion related to respiration, bulk
cardiac motion during the cardiac cycle adds another boundary condition
to coronary vessel wall measurements. Imaging during mid diastole
minimizes motion-related
artifacts.8 9
As previously reported by our
group,7 reduction of
the acquisition window from 120 to 60 ms significantly improves the
quality of coronary MRA. Based on this knowledge, we chose a relatively
short acquisition window of 50 ms. With this acquisition window
duration and a linear k-space acquisition scheme, an echo time of 25 ms
was chosen according to our simulations as the optimal effective echo
time (TE=T2/2) for maximal SNR of smooth muscle and maximal CNR between
smooth muscle and epicardial fat (Appendix). As a beneficial side
effect of the short acquisition window, the point-spread function could
be kept small,26
which is essential for high-resolution vessel wall measurements.
Compared with bright-blood techniques, TSE techniques have the
advantage that they are relatively insensitive to complex or turbulent
flow, thus allowing for artifact-free visualization even of diseased
stenotic vessels.27
Furthermore, these techniques are especially well suited for the
visualization of smaller vessels such as the coronary arteries, because
the artifact level decreases with smaller vessel
size.27
Conclusions
In vivo free-breathing coronary vessel wall and plaque
imaging with MR has been successfully implemented in humans. Coronary
wall thickness and wall area were significantly higher in patients with
angiographic CAD, which suggests that MR vessel wall imaging can
visualize atherosclerotic plaque in vivo. The presented technique might
have potential applications in patients with known or suspected
atherosclerotic CAD or for serial evaluation after pharmacological
intervention.
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Acknowledgments |
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Dr Warren Manning is an Established Investigator of the American Heart Association (97000YN). The authors thank Dr Leo Mollewanger and Jouke Smink from Philips Medical Systems, Best, The Netherlands, for their many helpful discussions.
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Footnotes |
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Reprint requests to René M. Botnar, PhD, Beth Israel Deaconess Medical Center, Cardiovascular Division, Cardiac MR Center, 330 Brookline Ave, Boston, MA 02215.
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Appendix 1 |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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In a fast spin-echo sequence (TSE), the signal of a uniform voxel decays exponentially with the T2 relaxation time during the course of the echo train and is directly proportional to the number of signal averages. Compared with a conventional spin-echo sequence, the echo time (TE) has to be modified by the eTE, which depends on the k-space acquisition scheme.26
 | (3) |
 | (4) |
 | (5) |
 | (6) |
. Optimization of SNR with respect to
ESP yields an eTE that only depends on
T2.
 | (7) |
) and resulted in an eTE of 25
ms. The optimal contrast [(S1-S2)/N] between smooth muscle
and epicardial fat (T1=270 ms, T2=100 ms) and smooth muscle and lipids
(T1=500 ms, T2=30
ms11 ) was determined
numerically by plotting CNR with respect to eTE. Optimal contrast was
found at an eTE of 25 ms for epicardial fat and 60 ms for
lipids. Additionally, the influence of TRR on SNR was examined. There was a 21% gain in SNR between a TRR of 1 and 2, but the gain of 4% between a TRR of 2 and 3 heartbeats seems to be relatively small compared with the increase in measurement time.
Received April 18, 2000; revision received July 7, 2000; accepted July 14, 2000.
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References |
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TopAbstractIntroductionMethodsResultsDiscussionAppendix 1References |
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 D. Maintz, M. Ozgun, A. Hoffmeier, R. Fischbach, W. Y. Kim, M. Stuber, W. J. Manning, W. Heindel, and R. M. Botnar Selective coronary artery plaque visualization and differentiation by contrast-enhanced inversion prepared MRI Eur. Heart J., July 2, 2006; 27(14): 1732 - 1736. [Abstract] [Full Text] [PDF]
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 M. Katoh, E. Spuentrup, A. Buecker, T. Schaeffter, M. Stuber, R. W. Gunther, and R. M. Botnar MRI of Coronary Vessel Walls Using Radial k-Space Sampling and Steady-State Free Precession Imaging Am. J. Roentgenol., June 1, 2006; 186(6_Supplement_2): S401 - S406. [Abstract] [Full Text] [PDF]
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R. L. Wilensky, H. K. Song, and V. A. Ferrari Role of magnetic resonance and intravascular magnetic resonance in the detection of vulnerable plaques. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C48 - C56. [Abstract] [Full Text] [PDF]
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E. Spuentrup, A. Ruebben, A. Mahnken, M. Stuber, C. Kolker, T. H. Nguyen, R. W. Gunther, and A. Buecker Artifact-Free Coronary Magnetic Resonance Angiography and Coronary Vessel Wall Imaging in the Presence of a New, Metallic, Coronary Magnetic Resonance Imaging Stent Circulation, March 1, 2005; 111(8): 1019 - 1026. [Abstract] [Full Text] [PDF]
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P. G. Danias, A. Roussakis, and J. P.A. Ioannidis Diagnostic performance of coronary magnetic resonance angiography as compared against conventional x-ray angiography: A meta-analysis J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1867 - 1876. [Abstract] [Full Text] [PDF]
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D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]
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U. J. Schoepf, C. R. Becker, B. M. Ohnesorge, and E. K. Yucel CT of Coronary Artery Disease Radiology, July 1, 2004; 232(1): 18 - 37. [Abstract] [Full Text] [PDF]
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V. Mani, V. V. Itskovich, M. Szimtenings, J. G. S. Aguinaldo, D. D. Samber, G. Mizsei, and Z. A. Fayad Rapid Extended Coverage Simultaneous Multisection Black-Blood Vessel Wall MR Imaging Radiology, July 1, 2004; 232(1): 281 - 288. [Abstract] [Full Text] [PDF]
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M. J. Budoff, S. Achenbach, and A. Duerinckx Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1867 - 1878. [Abstract] [Full Text] [PDF]
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 C R Peebles Non-invasive coronary imaging: computed tomography or magnetic resonance imaging? Heart, June 1, 2003; 89(6): 591 - 594. [Full Text] [PDF]
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J. Bogaert, R. Kuzo, S. Dymarkowski, R. Beckers, J. Piessens, and F. E. Rademakers Coronary Artery Imaging with Real-time Navigator Three-dimensional Turbo-Field-Echo MR Coronary Angiography: Initial Experience Radiology, March 1, 2003; 226(3): 707 - 716. [Abstract] [Full Text] [PDF]
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 S. G. Worthley, G. Helft, V. Fuster, Z. A. Fayad, M. Shinnar, L. A. Minkoff, C. Schechter, J. T. Fallon, and J. J. Badimon A Novel Nonobstructive Intravascular MRI Coil: In Vivo Imaging of Experimental Atherosclerosis Arterioscler Thromb Vasc Biol, February 1, 2003; 23(2): 346 - 350. [Abstract] [Full Text] [PDF]
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 V. Fuster, R. Corti, Z.A. Fayad, and J.J. Badimon Understanding the pathophysiology of the arterial wall: which method should we choose? Magnetic resonance imaging Eur. Heart J. Suppl., September 1, 2002; 4(suppl_F): F41 - F46. [Abstract] [PDF]
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W. Y. Kim, M. Stuber, P. Bornert, K. V. Kissinger, W. J. Manning, and R. M. Botnar Three-Dimensional Black-Blood Cardiac Magnetic Resonance Coronary Vessel Wall Imaging Detects Positive Arterial Remodeling in Patients With Nonsignificant Coronary Artery Disease Circulation, July 16, 2002; 106(3): 296 - 299. [Abstract] [Full Text] [PDF]
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R. P. Choudhury, V. Fuster, J. J. Badimon, E. A. Fisher, and Z. A. Fayad MRI and Characterization of Atherosclerotic Plaque: Emerging Applications and Molecular Imaging Arterioscler Thromb Vasc Biol, July 1, 2002; 22(7): 1065 - 1074. [Abstract] [Full Text] [PDF]
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 L. J. Walker, A. Ismail, W. McMeekin, D. Lambert, A. D. Mendelow, and D. Birchall Computed Tomography Angiography for the Evaluation of Carotid Atherosclerotic Plaque: Correlation With Histopathology of Endarterectomy Specimens Stroke, April 1, 2002; 33(4): 977 - 981. [Abstract] [Full Text] [PDF]
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C.L. de Korte, S.G. Carlier, F. Mastik, M.M. Doyley, A.F.W. van der Steen, P.W. Serruys, and N. Bom Morphological and mechanical information of coronary arteries obtained with intravascular elastography. Feasibility study in vivo Eur. Heart J., March 1, 2002; 23(5): 405 - 413. [Abstract] [Full Text] [PDF]
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P J de Feyter and K Nieman New coronary imaging techniques: what to expect? Heart, March 1, 2002; 87(3): 195 - 197. [Full Text] [PDF]
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G. F. Greil, M. Stuber, R. M. Botnar, K. V. Kissinger, T. Geva, J. W. Newburger, W. J. Manning, and A. J. Powell Coronary Magnetic Resonance Angiography in Adolescents and Young Adults With Kawasaki Disease Circulation, February 26, 2002; 105(8): 908 - 911. [Abstract] [Full Text] [PDF]
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 S. Achenbach and W. G. Daniel Noninvasive Coronary Angiography -- An Acceptable Alternative? N. Engl. J. Med., December 27, 2001; 345(26): 1909 - 1910. [Full Text] [PDF]
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 Z. A. Fayad and V. Fuster Clinical Imaging of the High-Risk or Vulnerable Atherosclerotic Plaque Circ. Res., August 17, 2001; 89(4): 305 - 316. [Abstract] [Full Text] [PDF]
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E. Spuentrup, A. Ruebben, T. Schaeffter, W. J. Manning, R. W. Gunther, and A. Buecker Magnetic Resonance-Guided Coronary Artery Stent Placement in a Swine Model Circulation, February 19, 2002; 105(7): 874 - 879. [Abstract] [Full Text] [PDF]
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