(Circulation. 2000;102:506.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive In Vivo Human Coronary Artery Lumen and Wall Imaging Using Black-Blood Magnetic Resonance Imaging
From the Zena and Michael A. Wiener Cardiovascular Institute (Z.A.F., V.F., J.T.F., T.J., S.G.W., G.H., J.G.A., J.J.B., S.S.) and the Departments of Radiology (Z.A.F.), Medicine (V.F., J.T.F., J.J.B., S.S.), and Pathology (J.T.F.), Mount Sinai School of Medicine, New York, NY.
Correspondence to Zahi A. Fayad, PhD, Mount Sinai School of Medicine, Box 1234, New York, NY 10029. E-mail zahi.fayad{at}mssm.edu
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Abstract |
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Background—High-resolution MRI has the potential to noninvasively image the human coronary artery wall and define the degree and nature of coronary artery disease. Coronary artery imaging by MR has been limited by artifacts related to blood flow and motion and by low spatial resolution.
Methods and Results—We used a noninvasive black-blood (BB) MRI
(BB-MR) method, free of motion and blood-flow artifacts, for
high-resolution (down to 0.46 mm in-plane resolution and 3-mm
slice thickness) imaging of the coronary artery lumen and wall.
In vivo BB-MR of both normal and atherosclerotic human coronary
arteries was performed in 13 subjects: 8 normal subjects and 5 patients
with coronary artery disease. The average coronary wall
thickness for each cross-sectional image was 0.75±0.17 mm (range,
0.55 to 1.0 mm) in the normal subjects. MR images of
coronary arteries in patients with 
40% stenosis as
assessed by x-ray angiography showed localized wall thickness of
4.38±0.71 mm (range, 3.30 to 5.73 mm). The difference in
maximum wall thickness between the normal subjects and patients was
statistically significant (P<0.0001).
Conclusions—In vivo high-spatial-resolution BB-MR provides a unique new method to noninvasively image and assess the morphological features of human coronary arteries. This may allow the identification of atherosclerotic disease before it is symptomatic. Further studies are necessary to identify the different plaque components and to assess lesions in asymptomatic patients and their outcomes.
Key Words: atherosclerosis • magnetic resonance imaging • coronary disease
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Introduction |
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Acute ischemic coronary syndromes often result from the rupture of a mildly to moderately stenotic coronary artery plaque, leading to thrombus formation.1 2 3 Currently available imaging techniques for the diagnosis of coronary artery disease are limited. For example, coronary angiography demonstrates only the degree of luminal narrowing and fails to visualize the arterial wall. Moreover, arteries accommodate plaque growth through outward displacement of the vessel wall, thereby preserving lumen cross-sectional area.4 Other imaging techniques, such as intravascular ultrasound,5 fast CT,6 and angioscopy,7 have all advanced our understanding of atherosclerosis, but these techniques are invasive and yield limited information about plaque composition.
Recent in vivo studies of atherosclerotic plaques in animal models,8 9 carotid arteries,10 11 and aorta12 demonstrate that high-resolution MRI can noninvasively image the artery wall and assess plaque composition. Preliminary studies in a porcine model of atherosclerosis showed that the major difficulties of MR coronary wall imaging are due to the combination of cardiac and respiratory motion artifacts, the nonlinear course of the coronary arteries, and their relatively small size and location.13 Thus, an effective in vivo MRI technique for coronary artery imaging must overcome artifacts related to blood flow and cardiac, respiratory, and vessel wall motion to achieve high-resolution and high-contrast imaging.
Current white-blood non–contrast-enhanced MR coronary angiography (gradient-echo,14 echo planar,15 spiral,16 etc) provide no information about the coronary wall structure or atherosclerotic plaque characteristics. In this context, the concept of black-blood MRI (BB-MR) is promising, because the signal from static tissue is maximized and the transverse magnetization of flowing blood is made intentionally incoherent, leading to blood signal void.17 18
Therefore, by combining BB-MR with high-spatial-resolution and fast-data-acquisition imaging, both lumen and wall imaging of the coronary arteries should be possible. A number of different methods are available for BB-MR.17 18 19 20 21 However, none of these methods have been used for coronary lumen and wall imaging.
In this in vivo study of normal and atherosclerotic human coronary arteries, we use long-echo-train-length (ETL) fast-spin-echo (FSE) imaging with "velocity-selective" inversion preparatory pulses22 23 to nullify the signal from flowing blood. A cardiac phased-array surface coil for high-resolution coronary imaging (460- to 750-µm in-plane spatial resolution) is also used.24 The results of this study clearly demonstrate that normal and atherosclerotic human coronary wall imaging can be performed with high-resolution BB-MR methods.
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Methods |
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Subjects
We studied 13 subjects: 8 healthy subjects (mean age, 30 years; range, 25 to 37 years; 4 men) without a history of cardiovascular disease and 5 consecutive coronary artery disease patients (mean age, 68 years; range, 50 to 78 years; 3 men) with
40% stenosis as documented by x-ray
angiography. The MRI studies were performed within 24 hours of the
coronary contrast x-ray angiogram. Written informed consent was
obtained from all subjects, and the institutional review board approved
the protocol.
MR Imaging
MRI was performed on a 1.5-T whole-body MRI system (General
Electric Medical Systems, Signa) equipped with high-performance
gradient (40-mT/m amplitude, 150-mT ·
m-1 ·
ms-1 slew rate) and a
multichannel receiver with a maximal bandwidth of 250 kHz. A 4-element
(2 anterior and 2 posterior) specially designed cardiac phased-array
receiver surface coil was used for signal reception.24 ECG
electrodes were attached to trigger data acquisition and minimize
cardiac and vessel motion. All subjects were instructed to withhold
breathing at end expiration to minimize respiratory motion.
Breath-holding was confirmed by a bellows respiratory monitor.
Imaging Sequence
Fast scout gradient-echo images were acquired initially in the
coronal, sagittal, and transverse planes for localization. All imaging
was subsequently performed with a BB-MR sequence. The major features of
the BB-MR sequence are (1) velocity-selective inversion preparatory
pulses; (2) short RF excitation pulses; (3) optimized fat saturation;
and (4) long-ETL FSE imaging.
Velocity-Selective Inversion Preparatory Pulses
Velocity-selective inversion preparatory pulses were used to
suppress the signal from flowing blood, thereby avoiding possible flow
artifacts and providing a strong contrast between the dark flowing
blood and bright wall signal of the coronary arteries. The flow
suppression consisted of 2 inversion pulses: 1 nonselective 180°
inversion recovery (IR) pulse followed immediately by a slice-selective
180° inversion pulse.22 The first IR pulse inverts the
magnetization of the entire body, including all of the blood. Next, the
second IR pulse reinverts the imaging slice but leaves the blood
outside the slice inverted. The section thickness of the selective
inversion pulse was set to 3 times the slice thickness to accommodate
possible misregistration of tissue between the preparatory pulses and
data acquisition. The nonselective pulse consisted of a rectangular
"hard" pulse 1024 µs long. The selective pulse was a
hyperbolic-secant pulse 8640 µs long.25 This provided
good B1 insensitivity and inversion profile.
The velocity-selective inversion pulses were placed at end
diastole (after the detection of the ECG trigger), and the
data acquisition occurred during diastole. This process
maximized the blood flow suppression due to outflow and also minimized
artifacts due to vessel motion. Image acquisition started after a
predetermined inversion time (TI). The delay time or TI for the
velocity-selective inversion preparatory pulses was determined close to
the null point of the blood signal (see equation). TI is based on the
T1 relaxation value of the blood and the TR interval:
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Short Optimized RF Pulses
The data acquisition is performed with an FSE sequence. As usual
for the FSE sequence, the time between the 90° excitation pulse and
the first refocusing pulse is half the time between the neighboring
refocusing pulses (the echo spacing; ESP). The strong and fast
gradients made possible very compact echo trains. To further shorten
the ESP, short radiofrequency (RF) pulses optimized by use of the
Shinnar-LeRoux algorithm were used.26 The RF excitation
pulses were 1.2 ms long. The refocusing pulse had a flip angle of
155°. With a data acquisition sampling of 125 kHz and 256 frequency
points, an ESP as short as 3.9 ms was achievable. These pulses provided
reduced power deposition and reduced echo amplitude
unstabilities.27 28 29
Optimized Fat Suppression
In acquiring images of the coronary artery wall, the
velocity-selective inversion pulses were immediately followed by a
chemical shift–selective (CHESS) pulse. This pulse eliminated the
epicardial fat signal and thus enhanced the definition of the outer
boundary of the arteries. To take account of the multicomponent nature
of the fat signal, the CHESS pulse was optimized according to Kuroda et
al30 and resulted in improved fat suppression and
coronary wall visualization.
Long-ETL FSE Imaging
The preparatory pulses (velocity-selective inversion pulses and
CHESS pulse) were followed by an ECG-gated, long-ETL FSE imaging
sequence. The short ESP allowed the use of long-ETL data acquisition
without the disadvantage of T2 relaxation blurring.31 From
the initial scout images of the coronary arteries, 5 contiguous
transverse (cross-sectional) images of the lumen and wall of the
proximal segments of the right (RCA) and left anterior descending (LAD)
coronary arteries were acquired in 13 subjects. Imaging was
performed during short periods of suspended respiration of 12 to 18
heartbeats per slice. One way to restrict the number of phase-encoding
steps is to reduce the field of view (FOV) in the phase-encoding
direction. However, for a small FOV, this may result in back-folding
artifacts. Therefore, when this was the case, we disabled the 2
posterior coil elements of our 4-coil-elements anterior and posterior
phased-array coil by a user-controlled variable just before
imaging.
The imaging parameters were TR=2 RR intervals, TE=40 ms, asymmetric (3/4) FOV in the phase encoding direction (in some of the images), 18- to 29-cm FOV, 3- to 5-mm slice thickness, no interslice gap, 384x384 or 384x256 acquisition matrix, number of signals averaged (NSA) 1, 32 ETL, 125-kHz data sampling. The in-plane resolution was 0.46 to 0.75 mm.
Image Analysis
The MR images were transferred to a Macintosh computer for
analysis. The inner (ie, lumen) and outer (eg,
adventitial-medial) boundaries of the vessels were traced
semiautomatically with ImagePro Plus (Media Cybernetics). The
semiautomatic tracing tool works by following an edge (ie, boundary) of
significant contrast. The maximal wall thickness was determined from
each cross-sectional image. The data were then analyzed with a
2-tailed unpaired Student’s t test. A value of
P<0.05 was considered to be statistically significant.
Values are mean±SEM.
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Results |
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All the images demonstrated excellent flow suppression and high contrast and signal-to-noise in the coronary arteries and clearly delineated the coronary wall. Cross-sectional images of normal coronary artery wall showed a circular lumen surrounded by a uniform thin wall (Figure 1
). A
transverse lumen image obtained without fat saturation (Figure 1A) and wall image obtained with fat saturation (Figure 1B) of the proximal LAD from a normal subject are shown. In this
subject, the maximum wall thickness of the LAD measures 
0.8
mm.
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Figure 2 shows the ectatic
atherosclerotic coronary arteries and thickened
coronary wall of a 45-year-old male patient. The BB-MR
cross-sectional lumen image reveals a circular lumen and an anterior
plaque (arrow, Figure 2A). The cross-sectional image of the wall
clearly reveals a variably thick proximal RCA, with the wall thinner
around the 6 o’clock position and thicker in the other sectors (Figure 2B). In that patient, the maximum wall thickness is 3.3 mm.
Figure 3A shows mild disease in the
proximal LAD as seen on x-ray angiography in a 78-year-old female
patient. The BB-MR cross-sectional lumen image reveals a circular lumen
(Figure 3B), and the wall image shows a concentric plaque
(maximum thickness of 4.13 mm) (Figure 3C). Figure 4A shows high-grade stenosis in
the proximal LAD on the x-ray angiogram in a 76-year-old male
patient. The cross-sectional coronary image at that location
shows an obstructed lumen (elliptical shape) on the BB-MR lumen image
(Figure 4B). The BB-MR wall image obtained with fat saturation
reveals a large eccentric plaque measuring 5.73 mm with
heterogeneous signal intensity, possibly due to the
different tissue composition (Figure 4C).
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In the normal subjects, the average maximum coronary wall thickness was 0.75±0.17 mm (range, 0.55 to 1.0 mm; n=40). MR images of coronary arteries in coronary artery disease patients showed atherosclerotic plaques 3.30 to 5.73 mm in maximum wall thickness (4.38±0.71 mm; n=25). The difference in maximum coronary wall thickness between the normal subjects and patients was statistically significant (P<0.0001).
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Discussion |
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This study demonstrates, for the first time, that in vivo MRI can provide high-spatial-resolution images of the coronary artery wall in normal and diseased human arteries. Vessel lumen and wall morphology in normal and atherosclerotic human coronary arteries was assessed with a high-resolution BB sequence consisting of the long-ETL FSE imaging method with velocity-selective inversion preparatory pulses to eliminate the signal from the flowing blood.
The coronary artery wall was clearly seen in all patients and had a distinct MR signal characteristic of surrounding tissue. Data obtained from comparative studies with standard histology and epivascular and intravascular ultrasound are in close agreement with the results of our study.32 33 34 35 Moreover, a recent study in pigs using a similar MRI technique showed an excellent correlation between matched in vivo coronary wall images and histopathology sections for average wall thickness.36
As seen in Figures 1 through 4
, the
in-plane spatial resolution used in this study (460 to 750 µm)
was adequate for the distinction between normal and diseased portions
of the coronary arteries and to quantify
coronary artery wall and plaque thickness.
Possible Further Improvements
The slice thickness of the MR image (3 to 5 mm) causes
volume averaging (ie, partial-volume effect) and can contribute to an
overestimation of the coronary wall. Thinner slice thickness,
as used with 3D acquisition techniques, could further improve our
coronary artery wall imaging.18 37 Moreover,
zero-filled interpolation of the 256x256 images can be used to create
512x512 images to reduce the partial-volume effects in imaging
pixels.38 This can be achieved by appending zeros on each
side of the data before Fourier transformation.
A relatively high spatial resolution of 0.46 to 0.75 mm was achieved by use of a specially tailored phased-array coil. Other coil designs, such as a smaller anterior 4-element phased-array coil, may improve the spatial resolution and allow the identification of the substructures within atherosclerotic coronary lesions.
The BB FSE sequence used in this study has flexible multicontrast capabilities (ie, proton-density or T2 weighting through direct manipulation of TE), which, with improvements in spatial resolution and image contrast,39 40 41 42 43 may allow the characterization of the different coronary plaque components.9 11 12 44 45
A misalignment of the imaging plane and the long axis of the vessel can lead to inaccurate cross-sectional images and lead to errors in wall thickness measurements and plaque imaging. Careful planning in this study minimized these errors. A 3D imaging sequence18 37 will allow image reformatting in any desired plane direction and thus ensure the proper alignment between the imaging plane and the course of the coronary arteries.
The effect of slowly flowing blood near the vessel walls is another phenomenon that could potentially degrade the accuracy of vessel wall imaging with BB techniques. However, preliminary results in our study and with a similar BB-MR sequence in the coronary arteries36 and in the brain46 suggest that this effect is minimal.
Breath-holding was used to suppress respiratory motion. This limits the maximal duration of the scan and may not be possible in certain patients. We have limited the breath-holding duration to 12 to 18 heartbeats (12 to 18 seconds for heartbeats of 60 bpm), which was well tolerated by all subjects. Adequate breath-holding was confirmed by respiratory bellows. Short breath-holding limits the achievable spatial resolution and data sampling for each image, which in turn leads to vessel wall imaging. These problems can be overcome only by a prolongation of the duration of the breath-holds, which is well tolerated in some patients, or by the use of navigator techniques to avoid breath-holding altogether.47 48 The reduction of the ESP will also lead to shorter breath-holds and reduction of vessel motion blurring.
We have visualized the major epicardial coronary arteries but not the side branches. However, coronary atherosclerosis most often involves the proximal portion of the coronary arteries, usually at or near branch sites.49 Evaluation of the whole extent of the epicardial coronary arteries will be developed in future studies. Moreover, validation and repeatability studies of the MRI findings need to be performed, possibly in patients undergoing intravascular ultrasound.
Clinical Implications
Atherosclerotic coronary artery plaque rupture is a key
event leading to acute coronary syndromes. In vivo MRI provides
a means to noninvasively image and assess the morphological features of
atherosclerotic and normal human coronary arteries. Future work
will certainly aim at the identification of the different plaque
components. This may allow the identification of the vulnerable plaques
before they rupture and may provide a way to target pharmacological
intervention to reduce or prevent cardiovascular
disease.
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Acknowledgments |
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This study was supported in part by a Radiological Society of North America seed grant (Dr Fayad) and NIH grants P50-HL-54469 and R01-HL-61801. We acknowledge the help of Karen Metroka, Stella Palencia, and Mary Ann Whelan-Gales in patient selection and recruitment. We thank Paul Wisdom and John Abela for help in MRI.
Received November 15, 1999; revision received February 22, 2000; accepted February 29, 2000.
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M. E. Clouse, A. Sabir, C.-S. Yam, N. Yoshimura, S. Lin, F. Welty, P. Martinez-Clark, and V. Raptopoulos Measuring Noncalcified Coronary Atherosclerotic Plaque Using Voxel Analysis with MDCT Angiography: A Pilot Clinical Study Am. J. Roentgenol., June 1, 2008; 190(6): 1553 - 1560. [Abstract] [Full Text] [PDF]
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 S. Voros Can Computed Tomography Angiography of the Coronary Arteries Characterize Atherosclerotic Plaque Composition?: Is the CAT (Scan) Out of the Bag? J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 183 - 185. [Full Text] [PDF]
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A. Sabir, C.-S. Yam, N. Yoshimura, J. L. Buros, A. M. De Grand, V. Raptopoulos, and M. E. Clouse Measuring Noncalcified Coronary Atherosclerotic Plaque Using Voxel Analysis with MDCT Angiography: Phantom Validation Am. J. Roentgenol., April 1, 2008; 190(4): W242 - W246. [Abstract] [Full Text] [PDF]
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 J. M S Lee and R. P Choudhury Prospects for atherosclerosis regression through increase in high-density lipoprotein and other emerging therapeutic targets Heart, May 1, 2007; 93(5): 559 - 564. [Abstract] [Full Text] [PDF]
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W. Y. Kim, A. S. Astrup, M. Stuber, L. Tarnow, E. Falk, R. M. Botnar, C. Simonsen, L. Pietraszek, P. R. Hansen, W. J. Manning, et al. Subclinical Coronary and Aortic Atherosclerosis Detected by Magnetic Resonance Imaging in Type 1 Diabetes With and Without Diabetic Nephropathy Circulation, January 16, 2007; 115(2): 228 - 235. [Abstract] [Full Text] [PDF]
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S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
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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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 P. Raggi, A. Taylor, Z. Fayad, D. O'Leary, S. Nissen, D. Rader, and L. J. Shaw Atherosclerotic Plaque Imaging: Contemporary Role in Preventive Cardiology Arch Intern Med, November 14, 2005; 165(20): 2345 - 2353. [Abstract] [Full Text] [PDF]
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M. Y. Desai, S. Lai, C. Barmet, R. G. Weiss, and M. Stuber Reproducibility of 3D free-breathing magnetic resonance coronary vessel wall imaging Eur. Heart J., November 1, 2005; 26(21): 2320 - 2324. [Abstract] [Full Text] [PDF]
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V. Fuster, Z. A. Fayad, P. R. Moreno, M. Poon, R. Corti, and J. J. Badimon Atherothrombosis and High-Risk Plaque: Part II: Approaches by Noninvasive Computed Tomographic/Magnetic Resonance Imaging J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1209 - 1218. [Abstract] [Full Text] [PDF]
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M. Sirol, V. Fuster, J. J. Badimon, J. T. Fallon, J.-F. Toussaint, and Z. A. Fayad Chronic Thrombus Detection With In Vivo Magnetic Resonance Imaging and a Fibrin-Targeted Contrast Agent Circulation, September 13, 2005; 112(11): 1594 - 1600. [Abstract] [Full Text] [PDF]
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V. Fuster and R. J. Kim Frontiers in Cardiovascular Magnetic Resonance Circulation, July 5, 2005; 112(1): 135 - 144. [Full Text] [PDF]
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A. Yonemura, Y. Momiyama, Z. A. Fayad, M. Ayaori, R. Ohmori, K. Higashi, T. Kihara, S. Sawada, N. Iwamoto, M. Ogura, et al. Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging J. Am. Coll. Cardiol., March 1, 2005; 45(5): 733 - 742. [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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J. F Viles-Gonzalez, V. Fuster, and J. J Badimon Atherothrombosis: A widespread disease with unpredictable and life-threatening consequences Eur. Heart J., July 2, 2004; 25(14): 1197 - 1207. [Abstract] [Full Text] [PDF]
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 E. Castillo, H. Tandri, E. R. Rodriguez, K. Nasir, J. Rutberg, H. Calkins, J. A. C. Lima, and D. A. Bluemke Arrhythmogenic Right Ventricular Dysplasia: Ex Vivo and in Vivo Fat Detection with Black-Blood MR Imaging Radiology, July 1, 2004; 232(1): 38 - 48. [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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 S.E. Nissen Identifying patients at risk: novel diagnostic techniques Eur. Heart J. Suppl., July 1, 2004; 6(suppl_C): C15 - C20. [Abstract] [Full Text] [PDF]
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M. Sirol, V. V. Itskovich, V. Mani, J. G. S. Aguinaldo, J. T. Fallon, B. Misselwitz, H.-J. Weinmann, V. Fuster, J.-F. Toussaint, and Z. A. Fayad Lipid-Rich Atherosclerotic Plaques Detected by Gadofluorine-Enhanced In Vivo Magnetic Resonance Imaging Circulation, June 15, 2004; 109(23): 2890 - 2896. [Abstract] [Full Text] [PDF]
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J. T. Willerson and P. M. Ridker Inflammation as a Cardiovascular Risk Factor Circulation, June 1, 2004; 109(21_suppl_1): II-2 - II-10. [Abstract] [Full Text] [PDF]
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 G J Heatlie and K Pointon Cardiac magnetic resonance imaging Postgrad. Med. J., January 1, 2004; 80(939): 19 - 22. [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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 B. D. MacNeill, H. C. Lowe, M. Takano, V. Fuster, and I.-K. Jang Intravascular Modalities for Detection of Vulnerable Plaque: Current Status Arterioscler Thromb Vasc Biol, August 1, 2003; 23(8): 1333 - 1342. [Abstract] [Full Text] [PDF]
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S. Zhang, J. Cai, Y. Luo, C. Han, N. L. Polissar, T. S. Hatsukami, and C. Yuan Measurement of Carotid Wall Volume and Maximum Area with Contrast-enhanced 3D MR Imaging: Initial Observations Radiology, July 1, 2003; 228(1): 200 - 205. [Abstract] [Full Text] [PDF]
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R. F. Redberg, R. A. Vogel, M. H. Criqui, D. M. Herrington, J. A. C. Lima, and M. J. Roman Task force #3--what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1886 - 1898. [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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R. S. Blumenthal, D. M. Becker, L. R. Yanek, T. R. Aversano, T. F. Moy, B. G. Kral, and L. C. Becker Detecting Occult Coronary Disease in a High-Risk Asymptomatic Population Circulation, February 11, 2003; 107(5): 702 - 707. [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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Z. A. Fayad, V. Fuster, K. Nikolaou, and C. Becker Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging: Current and Potential Future Concepts Circulation, October 8, 2002; 106(15): 2026 - 2034. [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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 A. Buffon, L. M. Biasucci, G. Liuzzo, G. D'Onofrio, F. Crea, and A. Maseri Widespread Coronary Inflammation in Unstable Angina N. Engl. J. Med., July 4, 2002; 347(1): 5 - 12. [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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R. Corti, J. I. Osende, Z. A. Fayad, J. T. Fallon, V. Fuster, G. Mizsei, E. Dickstein, B. Drayer, and J. J. Badimon In vivo noninvasive detection and age definition of arterial thrombus by MRI J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1366 - 1373. [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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 T. C. Gerber, R. S. Kuzo, N. Karstaedt, G. E. Lane, R. L. Morin, P. F Sheedy II, R. E. Safford, J. L. Blackshear, and J. H. Pietan Current Results and New Developments of Coronary Angiography With Use of Contrast-Enhanced Computed Tomography of the Heart Mayo Clin. Proc., January 1, 2002; 77(1): 55 - 71. [Abstract] [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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S. Flacke, S. Fischer, M. J. Scott, R. J. Fuhrhop, J. S. Allen, M. McLean, P. Winter, G. A. Sicard, P. J. Gaffney, S. A. Wickline, et al. Novel MRI Contrast Agent for Molecular Imaging of Fibrin: Implications for Detecting Vulnerable Plaques Circulation, September 11, 2001; 104(11): 1280 - 1285. [Abstract] [Full Text] [PDF]
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M. T. Johnstone, R. M. Botnar, A. S. Perez, R. Stewart, W. C. Quist, J. A. Hamilton, and W. J. Manning In Vivo Magnetic Resonance Imaging of Experimental Thrombosis in a Rabbit Model Arterioscler Thromb Vasc Biol, September 1, 2001; 21(9): 1556 - 1560. [Abstract] [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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P. Schoenhagen, K. M. Ziada, D. G. Vince, S. E. Nissen, and E. M. Tuzcu Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis J. Am. Coll. Cardiol., August 1, 2001; 38(2): 297 - 306. [Abstract] [Full Text] [PDF]
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R. Corti, Z. A. Fayad, V. Fuster, S. G. Worthley, G. Helft, J. Chesebro, M. Mercuri, and J. J. Badimon Effects of Lipid-Lowering by Simvastatin on Human Atherosclerotic Lesions: A Longitudinal Study by High-Resolution, Noninvasive Magnetic Resonance Imaging Circulation, July 17, 2001; 104(3): 249 - 252. [Abstract] [Full Text] [PDF]
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D. Pennell IMAGING TECHNIQUES: Cardiovascular magnetic resonance Heart, May 1, 2001; 85(5): 581 - 589. [Full Text]
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I. Gradus-Pizlo, S. G. Sawada, D. Wright, D. S. Segar, and H. Feigenbaum Detection of subclinical coronary atherosclerosis using two-dimensional, high-resolution transthoracic echocardiography J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1422 - 1429. [Abstract] [Full Text] [PDF]
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D. Li, J. C. Carr, S. M. Shea, J. Zheng, V. S. Deshpande, P. A. Wielopolski, and J. P. Finn Coronary Arteries: Magnetization-prepared Contrast-enhanced Three-dimensional Volume-targeted Breath-hold MR Angiography Radiology, April 1, 2001; 219(1): 270 - 277. [Abstract] [Full Text]
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 R. J. Lefkowitz and J. T. Willerson Prospects for Cardiovascular Research JAMA, February 7, 2001; 285(5): 581 - 587. [Abstract] [Full Text] [PDF]
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 W. Moshage, S. Achenbach, and W. G. Daniel Novel approaches to the non-invasive diagnosis of coronary-artery disease Nephrol. Dial. Transplant., January 1, 2001; 16(1): 21 - 28. [Full Text] [PDF]
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R. M. Botnar, M. Stuber, K. V. Kissinger, W. Y. Kim, E. Spuentrup, and W. J. Manning Noninvasive Coronary Vessel Wall and Plaque Imaging With Magnetic Resonance Imaging Circulation, November 21, 2000; 102(21): 2582 - 2587. [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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