ABSTRACT
Coronary artery disease (CAD) is the leading cause of mortality in the Western world, with the majority of the life-threatening cardiac events occurring without any previous symptoms. Current functional imaging techniques such as magnetic resonance or scintigraphy myocardial perfusion only provide insights on the later stages of the disease, when the severity of the condition may cause coronary lumen narrowing resulting in myocardial ischemia. Furthermore, early CAD often manifests as positive remodelling of the coronary vessel wall, which remains undetected by conventional luminographic imaging approaches such as invasive angiography. A non-invasive imaging technique that is capable of visualizing the coronary lumen and detecting coronary plaque including intraplaque hemorrhage and inflammation—associated to unstable coronary plaque—would be highly desirable. Magnetic resonance imaging (MRI) is a promising and non-invasive imaging modality for the detection and monitoring of CAD progression. With its capability of generating different imaging contrasts, MRI has shown feasibility to detect not only coronary luminal narrowing, but also outward growth of the coronary vessel wall, presence of intraplaque hemorrhage and inflammation, and the presence of intraluminal thrombosis, one of the most important manifestations of acute coronary syndrome. Several technical challenges are currently hindering a broad adoption of coronary MRI in clinical practice. Specifically, the coronary arteries are small and tortuous vessels that are constantly moving due to respiration and myocardial contraction. The need to image the coronary tree with high spatial resolution and extensive volumetric coverage entails prolonged data acquisition times. Therefore, ongoing research efforts aim at optimizing data acquisition and reconstruction strategies that could enable the acquisition of a large amount of imaging data within a clinically feasible acquisition time, while optimizing and improving approaches for cardiac and respiratory motion detection and compensation. The aim of this chapter is to review the state-of-the-art techniques in coronary MRI, as well as to provide insights on the latest technical developments and future clinical perspectives.
