An accurate, noninvasive technique for the diagnosis of coronary disease would be an important advance. We investigated the accuracy of coronary magnetic resonance angiography among patients with suspected coronary disease in a prospective, multicenter study.

Background —Three-dimensional (3D) navigator-gated and prospectively corrected free-breathing coronary magnetic resonance angiography (MRA) allows for submillimeter image resolution but suffers from poor contrast between coronary blood and myocardium. Data collected over >100 ms/heart beat are also susceptible to bulk cardiac and respiratory motion. To address these problems, we examined the effect of a T2 preparation prepulse (T2prep) for myocardial suppression and a shortened acquisition window on coronary definition. Methods and Results —Eight healthy adult subjects and 5 patients with confirmed coronary artery disease (CAD) underwent free-breathing 3D MRA with and without T2prep and with 120- and 60-ms data-acquisition windows. The T2prep resulted in a 123% ( P <0.001) increase in contrast-to-noise ratio (CNR). Coronary edge definition was improved by 33% ( P <0.001). Acquisition window shortening from 120 to 60 ms resulted in better vessel definition (11%; P <0.001). Among patients with CAD, there was a good correspondence with disease. Conclusions —Free-breathing, T2prep, 3D coronary MRA with a shorter acquisition window resulted in improved CNR and better coronary artery definition, allowing the assessment of coronary disease. This approach offers the potential for free-breathing, noninvasive assessment of the major coronary arteries.

To prospectively evaluate whether scar caused by radiofrequency (RF) ablation of the left atrium (LA) in patients with atrial fibrillation can be depicted with high-spatial-resolution delayed enhancement magnetic resonance (MR) imaging. All 23 subjects (16 men, seven women; mean age, 54 years +/- 13 [standard deviation]) provided written informed consent; the study was approved by the local institutional review board and was HIPAA compliant. A high-spatial-resolution free-breathing delayed enhancement MR imaging method was developed to detect scar (ie, ablated tissue) in the LA and pulmonary veins (PVs). The LA in 15 patients before ablation and in 18 patients at least 30 days after ablation was examined. A reader with 4 years of experience assessed presence of delayed enhancement on images and circumferential completeness. Signal-to-noise and contrast-to-noise ratios were measured and compared with an unpaired t test. The relationship between measurements of enhancement thickness at the interatrial septum and the number of days after ablation was investigated. No subject demonstrated preablation delayed enhancement of the atrial or PV wall, whereas postablation delayed enhancement was identified in all (100%). In patients after ablation, a partial to completely circumferential delayed enhancement pattern could be identified for the left inferior PV that encompassed 88% +/- 11 of the circumference, but only 62% of patients demonstrated more than 90% circumferential delayed enhancement. The signal-to-noise ratio of blood was 12, and the signal-to-noise ratios of the pre- and postablation left atrial wall were 15 and 22, respectively (P<.05). A relationship between delayed enhancement wall thickness and the inverse of the time interval from ablation was identified (P<.05). High-spatial-resolution delayed enhancement MR imaging allows noninvasive identification of scar induced by RF ablation following isolation therapy of the PV.

The efficient delivery of nanomaterials to specific targets for in vivo biomedical imaging is hindered by rapid sequestration by the reticuloendothelial system (RES) and consequent short circulation times. To overcome these two problems, we have prepared a new stealth PEG polymer conjugate containing a terminal 1,1-bisphosphonate (BP) group for strong and stable binding to the surface of ultrasmall-superparamagnetic oxide nanomaterials (USPIOs). This polymer, PEG(5)-BP, can be used to exchange the hydrophobic surfactants commonly used in the synthesis of USPIOs very efficiently and at room temperature using a simple method in 1 h. The resulting nanoparticles, PEG(5)-BP-USPIOs are stable in water or saline for at least 7 months and display a near-zero ζ-potential at neutral pH. The longitudinal (r₁) and transverse (r₂) relaxivities were measured at a clinically relevant magnetic field (3 T), revealing a high r₁ of 9.5 mM^–1 s^–1 and low r₂/r₁ ratio of 2.97, making these USPIOs attractive as T1-weighted MRI contrast agents at high magnetic fields. The strong T1-effect was demonstrated in vivo, revealing that PEG(5)-BP-USPIOs remain in the bloodstream and enhance its signal 6-fold, allowing the visualization of blood vessels and vascular organs with high spatial definition. Furthermore, the optimal relaxivity properties allow us to inject a dose 4 times lower than with other USPIOs. PEG(5)-BP-USPIOs can also be labeled using a radiolabeled-BP for visualization with single photon emission computed tomography (SPECT), and thus affording dual-modality contrast. The SPECT studies confirmed low RES uptake and long blood circulation times (t_1/2 = 2.97 h). These results demonstrate the potential of PEG(5)-BP-USPIOs for the development of targeted multimodal imaging agents for molecular imaging.

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 0.5×1.0 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 mm ² ) 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.