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Editorials

Noninvasive Coronary Imaging

The Contest Between Magnetic Resonance and Computed Tomographic Coronary Angiography

Pim J. de Feyter, MD and Robert-Jan van Geuns, MD

From the Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.

Correspondence to Pim J. de Feyter, MD, Departments of Cardiology and Radiology, Erasmus Medical Center, Room Hs 207, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail p.j.defeyter@erasmusmc.nl

Key Words: imaging • magnetic resonance imaging • tomography • noninvasive imaging

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Noninvasive coronary imaging is often considered the Holy Grail among cardiologists and radiologists interested in the diagnosis and treatment of coronary atherosclerosis.^1–3 That noninvasive coronary imaging would aid in establishing new prevention and treatment strategies in a wide range of clinical scenarios, ranging from early subclinical diagnosis of atherosclerosis in asymptomatic individuals to evaluation and monitoring of coronary stenoses in symptomatic patients with new onset of symptoms or with known coronary artery disease. Remarkable engineering accomplishments have made it possible to visualize the coronary arteries although they are small, tortuous, and do not run in a single plane. Cardiac and respiratory motion makes it difficult to "freeze" the heart to create a sharp coronary image. Two noninvasive diagnostic modalities have emerged, magnetic resonance coronary angiography (MR-CA) and computed tomographic coronary angiography (CT-CA), that allow visualization of the coronary arteries. Each technique has its own advantages and disadvantages (Table 1), and comparison of both contemporary techniques is the obvious way to establish which would be preferable in current clinical practice.

View this table:   Table 1. Comparison of Contemporary MR-CA With CT-CA Techniques

 

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Earlier studies compared 3-dimensional, navigator-gated, free-breathing MR-CA with CT-CA. In a small study of 27 patients, Gerber et al⁴ demonstrated that MR-CA had a higher diagnostic accuracy than 4-slice CT-CA in the evaluation of coronary stenoses, although both techniques had comparably high negative predictive values, which made them suitable to rule out significant coronary artery disease. In a follow-up study, the same group of investigators compared 3-dimensional, . . . [Full Text of this Article]