Diagnostic Performance of Self-navigated Whole-Heart Contrast-enhanced Coronary 3-T MR Angiography

Motion robust coronary MR angiography using zigzag centric ky-kz trajectory and high-resolution deep learning reconstruction

PURPOSE

To develop a new MR coronary angiography (MRCA) technique by employing a zigzag fan-shaped centric ky-kz k-space trajectory combined with high-resolution deep learning reconstruction (HR-DLR).

METHODS

All imaging data were acquired from 12 healthy subjects and 2 patients using two clinical 3-T MR imagers, with institutional review board approval. Ten healthy subjects underwent both standard 3D fast gradient echo (sFGE) and centric ky-kz k-space trajectory FGE (cFGE) acquisitions to compare the scan time and image quality. Quantitative measures were also performed for signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) as well as sharpness of the vessel. Furthermore, the feasibility of the proposed cFGE sequence was assessed in two patients. For assessing the feasibility of the centric ky-kz trajectory, the navigator-echo window of a 30-mm threshold was applied in cFGE, whereas sFGE was applied using a standard 5-mm threshold. Image quality of MRCA using cFGE with HR-DLR and sFGE without HR-DLR was scored in a 5-point scale (non-diagnostic = 1, fair = 2, moderate = 3, good = 4, and excellent = 5). Image evaluation of cFGE, applying HR-DLR, was compared with sFGE without HR-DLR. Friedman test, Wilcoxon signed-rank test, or paired t tests were performed for the comparison of related variables.

RESULTS

The actual MRCA scan time of cFGE with a 30-mm threshold was acquired in less than 5 min, achieving nearly 100% efficiency, showcasing its expeditious and robustness. In contrast, sFGE was acquired with a 5-mm threshold and had an average scan time of approximately 15 min. Overall image quality for MRCA was scored 3.3 for sFGE and 2.7 for cFGE without HR-DLR but increased to 3.6 for cFGE with HR-DLR and (p < 0.05). The clinical result of patients obtained within 5 min showed good quality images in both patients, even with a stent, without artifacts. Quantitative measures of SNR, CNR, and sharpness of vessel presented higher in cFGE with HR-DLR.

CONCLUSION

Our findings demonstrate a robust, time-efficient solution for high-quality MRCA, enhancing patient comfort and increasing clinical throughput.

Diagnostic performance of 3.0 T unenhanced Dixon water-fat separation coronary MR angiography in patients with low-to-intermediate risk of coronary artery disease

PURPOSE

To evaluate the diagnostic performance of 3.0 T unenhanced compressed-sensing sensitivity encoding (CS-SENSE) Dixon water-fat separation coronary MR angiography (CMRA) in patients with low-to-intermediate risk of coronary artery disease (CAD) and its ability to grade the severity of CAD based on Coronary Artery Disease Reporting and Data System (CAD-RADS).

METHODS

A total of 55 patients who was clinically evaluated as low-to-intermediate risk of CAD were finally included to undergo both 3.0 T CS-SENSE water-fat separation CMRA and coronary computed tomography angiography (CCTA), and 11 of them also underwent X-ray coronary angiography (CAG). The severity of coronary artery disease was graded in patients who had completed both CCTA and CMRA examinations by the use of CAD-RADS reports for the patients with stable chest pain, and the diagnostic consistency between the two approaches was evaluated. Diagnostic performance of CMRA was assessed using the combination of CCTA and CAG as the reference standard for excluding or confirming CAD respectively.

RESULTS

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 3.0 T unenhanced water-fat separation coronary MRA were 90.0%, 95.0%, 81.8%, 97.4% and 94.0% for a patient-based analysis respectively. In comparison with CCTA, 3.0 T Dixon water-fat separation CMRA demonstrated excellent consistency in grading the severity of coronary heart disease according to CAD-RADS (0.77 for kappa value).

CONCLUSION

In the group of low-to-intermediate probability for CAD, 3.0 T unenhanced CS-SENSE Dixon water-fat separation CMRA can present satisfactory diagnostic performance for the exclusion of CAD with high sensitivity and negative predictive value as well as the evaluation of grading the severity of coronary artery disease.

A clinical strategy to improve the diagnostic performance of 3T non-contrast coronary MRA and noninvasively evaluate coronary distensibility: combination of diastole and systole imaging

BACKGROUND

The clinical application of coronary MR angiography (MRA) combining diastole and systole imaging has never been described comprehensively in coronary artery disease (CAD) patients. We aimed to design an optimal non-contrast coronary MRA scan protocol combining diastolic and systolic imaging and to (1) evaluate its diagnostic performance for detecting significant coronary stenosis; (2) evaluate the feasibility of this protocol to noninvasively measure the coronary distensibility index (CDI).

METHODS

From June 2021 to May 2022, 33 healthy volunteers and 91 suspected CAD patients scheduled for X-ray coronary angiography (CAG) were prospectively enrolled. 3T non-contrast water-fat coronary MRA was carried out twice at diastole and systole. Significant coronary stenosis was defined as a luminal diameter reduction of ≥ 50% using CAG as the reference and was evaluated as follows: (1) by coronary MRA in diastole alone; (2) by coronary MRA in systole alone; (3) by combined coronary MRA in diastole and systole. According to CAG, the patients were divided into significant CAD patients and non-significant CAD patients. The difference in CDI among participants was evaluated.

RESULTS

Combined coronary MRA was completed in 31 volunteers and 76 patients. The per-patient sensitivity, specificity, and accuracy of combined coronary MRA were 97.5%, 83.3%, and 90.8%, respectively. Compared with single diastolic mode, combined coronary MRA showed equally high sensitivity but improved specificity on a per-patient basis (83.3% vs. 63.9%, adjusted P = 0.013). The CDI tested by coronary MRA decreased incrementally from healthy volunteers to non-significant and significant CAD patients.

CONCLUSION

Compared with single-phase mode, 3 T non-contrast combined coronary MRA significantly improved specificity and may have potential to be a simple noninvasive method to measure CDI.

Feasibility of accelerated non-contrast-enhanced whole-heart bSSFP coronary MR angiography by deep learning-constrained compressed sensing

OBJECTIVES

To examine a compressed sensing artificial intelligence (CSAI) framework to accelerate image acquisition in non-contrast-enhanced whole-heart bSSFP coronary magnetic resonance (MR) angiography.

METHODS

Thirty healthy volunteers and 20 patients with suspected coronary artery disease (CAD) scheduled for coronary computed tomography angiography (CCTA) were enrolled. Non-contrast-enhanced coronary MR angiography was performed with CSAI, compressed sensing (CS), and sensitivity encoding (SENSE) methods in healthy participants and with CSAI in patients. Acquisition time, subjective image quality score, and objective image quality measurement (blood pool homogeneity, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) were compared among the three protocols. The diagnostic performance of CASI coronary MR angiography for predicting significant stenosis (≥ 50% diameter stenosis) on CCTA was evaluated. The Friedman test was performed to compare the three protocols.

RESULTS

Acquisition time was significantly shorter in the CSAI and CS groups than in the SENSE group (10.2 ± 3.2 min vs. 10.9 ± 2.9 min vs. 13.0 ± 4.1 min, p < 0.001). However, the CSAI approach had the highest image quality scores, blood pool homogeneity, mean SNR value, and mean CNR value (all p < 0.001) compared with the CS and SENSE approaches. The sensitivity, specificity, and accuracy of CSAI coronary MR angiography per patient were 87.5% (7/8), 91.7% (11/12), and 90.0% (18/20); those per vessel were 81.8% (9/11), 93.9% (46/49), and 91.7% (55/60); and those per segment were 84.6% (11/13), 98.0% (244/249), and 97.3% (255/262), respectively.

CONCLUSIONS

CSAI yielded superior image quality within a clinically feasible acquisition time in healthy participants and patients with suspected CAD.

CLINICAL RELEVANCE STATEMENT

The non-invasive and radiation-free CSAI framework could be a promising tool for rapid screening and comprehensive examination of the coronary vasculature in patients with suspected CAD.

KEY POINTS

• This prospective study showed that CSAI enables a reduction in acquisition time by 22% with superior diagnostic image quality compared with the SENSE protocol. • CSAI replaces the wavelet transform with a CNN as a sparsifying transform in the CS algorithm, achieving high coronary MR image quality with reduced noise. • CSAI achieved per-patient sensitivity of 87.5% (7/8) and specificity of 91.7% (11/12) respectively for detecting significant coronary stenosis.

Deep Learning-Based Acceleration of Compressed Sensing for Noncontrast-Enhanced Coronary Magnetic Resonance Angiography in Patients With Suspected Coronary Artery Disease

BACKGROUND

The clinical application of coronary MR angiography (MRA) remains limited due to its long acquisition time and often unsatisfactory image quality. A compressed sensing artificial intelligence (CSAI) framework was recently introduced to overcome these limitations, but its feasibility in coronary MRA is unknown.

PURPOSE

To evaluate the diagnostic performance of noncontrast-enhanced coronary MRA with CSAI in patients with suspected coronary artery disease (CAD).

STUDY TYPE

Prospective observational study.

POPULATION

A total of 64 consecutive patients (mean age ± standard deviation [SD]: 59 ± 10 years, 48.4% females) with suspected CAD.

FIELD STRENGTH/SEQUENCE

A 3.0-T, balanced steady-state free precession sequence.

ASSESSMENT

Three observers evaluated the image quality for 15 coronary segments of the right and left coronary arteries using a 5-point scoring system (1 = not visible; 5 = excellent). Image scores ≥3 were considered diagnostic. Furthermore, the detection of CAD with ≥50% stenosis was evaluated in comparison to reference standard coronary computed tomography angiography (CTA). Mean acquisition times for CSAI-based coronary MRA were measured.

STATISTICAL TESTS

For each patient, vessel and segment, sensitivity, specificity, and diagnostic accuracy of CSAI-based coronary MRA for detecting CAD with ≥50% stenosis according to coronary CTA were calculated. Intraclass correlation coefficients (ICCs) were used to assess the interobserver agreement.

RESULTS

The mean MR acquisition time ± SD was 8.1 ± 2.4 minutes. Twenty-five (39.1%) patients had CAD with ≥50% stenosis on coronary CTA and 29 (45.3%) patients on MRA. A total of 885 segments on the CTA images and 818/885 (92.4%) coronary MRA segments were diagnostic (image score ≥3). The sensitivity, specificity, and diagnostic accuracy were as follows: per patient (92.0%, 84.6%, and 87.5%), per vessel (82.9%, 93.4%, and 91.1%), and per segment (77.6%, 98.2%, and 96.6%), respectively. The ICCs for image quality and stenosis assessment were 0.76-0.99 and 0.66-1.00, respectively.

DATA CONCLUSION

The image quality and diagnostic performance of coronary MRA with CSAI may show good results in comparison to coronary CTA in patients with suspected CAD.

EVIDENCE LEVEL

1.

TECHNICAL EFFICACY

2.

3.0 T unenhanced Dixon water-fat separation whole-heart coronary magnetic resonance angiography: compressed-sensing sensitivity encoding imaging versus conventional 2D sensitivity encoding imaging

This study was aimed to investigate 3.0 T unenhanced Dixon water-fat whole-heart CMRA (coronary magnetic resonance angiography) using compressed-sensing sensitivity encoding (CS-SENSE) and conventional sensitivity encoding (SENSE) in vitro and in vivo. The key parameters of CS-SENSE and conventional 1D/2D SENSE were compared in vitro phantom study. In vivo study, fifty patients with suspected coronary artery disease (CAD) completed unenhanced Dixon water-fat whole-heart CMRA at 3.0 T using both CS-SENSE and conventional 2D SENSE methods. We compared mean acquisition time, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and the diagnostic accuracy between two techniques. In vitro study, CS-SENSE achieved better effectiveness between higher SNR/CNR and shorter scan times using the appropriate acceleration factor compared with conventional 2D SENSE. In vivo study, CS-SENSE CMRA had better performance than 2D SENSE in terms of the mean acquisition time, SNR and CNR (7.4 ± 3.2 min vs. 8.3 ± 3.4 min, P = 0.001; SNR: 115.5 ± 35.4 vs. 103.3 ± 32.2; CNR: 101.1 ± 33.2 vs. 90.6 ± 30.1, P < 0.001 for both). The diagnostic accuracy between CS-SENSE and 2D SENSE had no significant difference on a patient-based analysis (sensitivity: 97.3% vs. 91.9%; specificity: 76.9% vs. 61.5%; accuracy: 92.0% vs. 84.0%; P > 0.05 for each). Unenhanced CS-SENSE Dixon water-fat separation whole-heart CMRA at 3.0 T can improve the SNR and CNR, shorten the acquisition time while providing equally satisfactory image quality and diagnostic accuracy compared with 2D SENSE CMRA.

Diagnostic accuracy of whole heart coronary magnetic resonance angiography: a systematic review and meta-analysis

BACKGROUND

The purpose of this meta-analysis was to comprehensively investigate the diagnostic ability of 1.5 T and 3.0 T whole heart coronary angiography (WHCA) to detect significant coronary artery disease (CAD) on X-ray coronary angiography.

METHODS

A literature search of electronic databases, including PubMed, Web of Science Core Collection, Cochrane advanced search, and EMBASE, was performed to retrieve and integrate articles showing significant CAD detectability of 1.5 and 3.0 T WHCA.

RESULTS

Data from 1899 patients from 34 studies were included in the meta-analysis. 1.5 T WHCA had a summary area under ROC of 0.88 in the patient-based analysis, 0.90 in the vessel-based analysis, and 0.92 in the segment-based analysis. These values for 3.0 T WHCA were 0.94, 0.95, 0.96, respectively. Contrast-enhanced 3.0 T WHCA had significantly higher specificity than non-contrast-enhanced 1.5 T WHCA on a patient-based analysis (0.87, 95% CI 0.80-0.92 vs. 0.74, 95% CI 0.64-0.82, P = 0.02). There were no differences in diagnostic performance on a patient-based analysis by use of vasodilators, beta-blockers or between Asian and Western countries.

CONCLUSIONS

The diagnostic performance of WHCA was deemed satisfactory, with contrast-enhanced 3.0 T WHCA exhibiting higher specificity compared to non-contrast-enhanced 1.5 T WHCA in a patient-based analysis. There were no significant differences in diagnostic performance on a patient-based analysis in terms of vasodilator or beta-blocker use, nor between Asian and Western countries. However, further large-scale multicentre studies are crucial for the widespread global adoption of WHCA.

3D whole-heart noncontrast coronary MR angiography based on compressed SENSE technology: a comparative study of conventional SENSE sequence and coronary computed tomography angiography

OBJECTIVE

The relatively long scan time has hampered the clinical use of whole-heart noncontrast coronary magnetic resonance angiography (NCMRA). The compressed sensitivity encoding (SENSE) technique, also known as the CS technique, has been found to improve scan times. This study aimed to identify the optimal CS acceleration factor for NCMRA.

METHODS

Thirty-six participants underwent four NCMRA sequences: three sequences using the CS technique with acceleration factors of 4, 5, and 6, and one sequence using the conventional SENSE technique with the acceleration factor of 2. Coronary computed tomography angiography (CCTA) was considered as a reference sequence. The acquisition times of the four NCMRA sequences were assessed. The correlation and agreement between the visible vessel lengths obtained via CCTA and NCMRA were also assessed. The image quality scores and contrast ratio (CR) of eight coronary artery segments from the four NCMRA sequences were quantitatively evaluated.

RESULTS

The mean acquisition time of the conventional SENSE was 343 s, while that of CS4, CS5, and CS6 was 269, 215, and 190 s, respectively. The visible vessel length from the CS4 sequence showed good correlation and agreement with CCTA. The image quality score and CR from the CS4 sequence were not statistically significantly different from those in the other groups (p > 0.05). Moreover, the image score and CR showed a decreasing trend with the increase in the CS factor.

CONCLUSIONS

The CS technique could significantly shorten the acquisition time of NCMRA. The CS sequence with an acceleration factor of 4 was generally acceptable for NCMRA in clinical settings to balance the image quality and acquisition time.

Cardiovascular Imaging in China: Yesterday, Today, and Tomorrow

The high prevalence and mortality of cardiovascular diseases in China's large population has increased the use of cardiovascular imaging for the assessment of conditions in recent years. In this study, we review the past 20 years of cardiovascular imaging in China, the increasingly important role played by cardiovascular computed tomography in coronary artery disease and pulmonary embolism assessment, magnetic resonance imaging's use for cardiomyopathy assessment, the development and application of artificial intelligence in cardiovascular imaging, and the future of Chinese cardiovascular imaging.

Assessment of Non-contrast-enhanced Dixon Water-fat Separation Compressed Sensing Whole-heart Coronary MR Angiography at 3.0 T: A Single-center Experience

RATIONALE AND OBJECTIVES

The clinical utility of Dixon water-fat separation coronary MR angiography (CMRA) with compressed sensing (CS) reconstruction has not been determined in a patient population. This study was designed to evaluate the performance of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA sequence in vitro and in vivo.

MATERIALS AND METHODS

In vitro phantom MRI, we compared key parameters of the SENSE and CS images. And in this prospective in vivo study, from November 2019 to October 2020, 94 participants were recruited for 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using X-ray coronary angiography (CA) as the reference method.

RESULTS

Compared with SENSE, CS with an appropriate acceleration factor offers both higher SNR/CNR (p < 0.05) and a shortened acquisition. Fifty-eight patients successfully completed the CMRA and CA. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA according to a patient-based analysis were 96.4%, 66.7%, 73.0%, 95.2% and 81.0%, respectively. The area under the receiver-operator characteristic (ROC) curve (AUC) of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA for detecting significant coronary artery stenosis is 0.908, 0.895, and 0.904 in patient-, vessel-, and segment-based analyses respectively.

CONCLUSION

3.0 T non-contrast-enhanced Dixon water-fat separation whole-heart CMRA using appropriate CS is a promising noninvasive and radiation-free technique to detect clinically significant coronary stenosis on patients with suspected CAD.

High relaxivity Gd3+-based organic nanoparticles for efficient magnetic resonance angiography

Contrast-enhanced MR angiography (MRA) is a critical technique for vascular imaging. Nevertheless, the efficacy of MRA is often limited by the low rate of relaxation, short blood-circulation time, and metal ion-released potential long-term toxicity of clinical available Gd-based contrast agents. In this work, we report a facile and efficient strategy to achieve Gd-chelated organic nanoparticles with high relaxivity for T₁-weighted MRA imaging. The Gd-chelated PEG-TCPP nanoparticles (GPT NPs) have been engineered composite structured consisting of Gd-chelated TCPP and PEG. The spherical structure of TCPP offers more chemical sites for Gd³⁺ coordination to improve the relaxivity and avoid leakage of the Gd³⁺ ions. The synthesized GPT NPs exhibit a high relaxation rate of 35.76 mM^− 1 s^− 1 at 3.0 T, which is higher than the rates for most reported MR contrast agents. Therefore, GPT NPs can be used for MRA with much stronger vascular signals, longer circulation time, and high-resolution arterial vascular visualization than those using clinical MR contrast agents at the same dose. This work may make the T₁ MRI contrast agents for high-resolution angiography possible and offer a new candidate for preclinical and clinical applications of MR vascular imaging and vascular disease diagnosis.

Unenhanced Whole-Heart Coronary MRA: Prospective Intraindividual Comparison of 1.5-T SSFP and 3-T Dixon Water-Fat Separation GRE Methods Using Coronary Angiography as Reference

Background: Coronary MRA is commonly performed at 1.5 T using SSFP acquisitions. Coronary MRA at 3 T is limited using SSFP due to impaired fat suppression and has been investigated typically using contrast-enhanced techniques. A Dixon fat-water separation gradient-recalled echo (GRE) method may enable high-quality unenhanced 3-T coronary MRA. Objective: To compare 1.5-T SSFP and 3-T Dixon water-fat separation GRE methods for unenhanced whole-heart coronary MRA in patients with suspected coronary artery disease (CAD). Methods: This prospective study included 44 patients (27 men, 17 women; mean age 59±8 years) with intermediate-to-high risk of CAD who underwent both 1.5-T SSFP and 3-T Dixon GRE coronary MRA examinations before coronary angiography (CAG). Two radiologists independently assessed coronary arteries in terms of subjective image quality (1-5 scale; 5=highest image quality), number of visible segments, apparent contrast-to-noise ratio (CNR; vs myocardium)), and presence of significant stenoses. Methods were compared using readers' mean values for apparent CNR and consensus interpretations for other measures. CAG served as reference standard for presence of stenoses. Results: Interobserver agreement expressed as kappa was 0.85 for image quality, 0.85 for segment visibility, and 0.83 for stenosis, and expressed as intraclass correlation coefficient was 0.92 for apparent CNR. Mean overall image quality score was 4.0±1.1 for 3-T Dixon GRE versus 3.0±1.2 for 1.5-T SSFP. Percentage of visible segments for 3-T Dixon GRE versus 1.5-T SSFP was 96.7% versus 88.9% for all segments, 96.9% versus 90.1% for distal segments, and 93.1% versus 77.2% for branch segments. Mean overall apparent CNR was 93.2±29.2 for 3-T Dixon GRE versus 80.8±27.9 for 1.5-T SSFP. 3-T Dixon GRE, compared with 1.5-T SSFP, showed higher sensitivity and specificity in per-vessel analysis (87.9% vs 77.3%; 83.3% vs 60.6%), per-segment analysis (84.6% vs 74.8%, 90.9% vs 79.6%), and per-segment analysis of distal and branch segments (89.7% vs 75.9%, 89.7% vs 73.7%). Conclusion: For unenhanced coronary MRA, 3-T unenhanced Dixon GRE had better image quality and diagnostic performance than 1.5-T SSFP, particularly for distal and branch segments. Clinical Impact: The 3-T Dixon GRE technique may be preferred to the current clinical standard of 1.5-T SSFP for unenhanced coronary MRA.

Clinical Application of Non-Contrast-Enhanced Dixon Water-Fat Separation Compressed SENSE Whole-Heart Coronary MR Angiography at 3.0 T With and Without Nitroglycerin

BACKGROUND

3.0 T non-contrast-enhanced nitroglycerin (NTG)-assisted whole-heart coronary magnetic resonance angiography (MRA) employing Dixon water-fat separation and compressed SENSE (CS-SENSE) acceleration is a promising method for diagnosing coronary artery disease (CAD).

PURPOSE

To evaluate the diagnostic performance of this technique for detecting clinically-relevant (≥50% diameter reducing) CAD and to evaluate the difference in NTG-induced coronary vasodilation between patients with and without clinically-relevant CAD.

STUDY TYPE

Prospective.

POPULATION

Sixty-six patients with suspected CAD.

FIELD STRENGTH/SEQUENCE

3.0 T; CSSENSE, Dixon water-fat separation, three-dimensional segmented turbo field gradient-echo sequence for whole-heart coronary MRA.

ASSESSMENT

Overall image quality of coronary MRA was calculated on the basis of all visible coronary segments. The diagnostic performance of coronary MRA for detecting a ≥50% reduction in coronary artery diameter with and without NTG was compared using X-ray coronary angiography (CAG) as the reference. According to CAG, patients were divided into a non-clinically-relevant CAD group and clinically-relevant CAD group, and the difference in NTG-induced vasodilation between the groups was evaluated.

STATISTICAL TESTS

Unpaired/paired Student's t-test, Mann-Whitney U test, paired Wilcoxon signed-rank test, χ² test, McNemar test. A two-tailed P value <0.05 was considered significant.

RESULTS

Overall image quality was increased significantly in the coronary MRA images after NTG. The diagnostic performance of the non-NTG vs. NTG-assisted coronary MRA was as follows on a per-patient basis: sensitivity 94.3% vs. 94.3%, specificity 64.5% vs. 83.9%, positive predictive value 75.0% vs. 86.8%, negative predictive value 90.9% vs. 92.9%, and accuracy 80.3% vs. 89.4%, respectively. NTG-induced vasodilation was significantly lower in the clinically-relevant CAD group than in the non-clinically-relevant CAD group (13.7 ± 8.1% vs. 24.1 ± 16.3%).

DATA CONCLUSION

Non-contrast Dixon water-fat separation CS-SENSE coronary MRA at 3.0 T can noninvasively detect clinically-relevant CAD and sublingual NTG improved performance. Combining pre- and post-NTG coronary MRA may provide a simple noninvasive and nonionizing test to evaluate coronary vasodilation function.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 2.

Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial

BACKGROUND

The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time.

OBJECTIVES

To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD.

METHODS

Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter.

RESULTS

The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively.

CONCLUSIONS

The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.

A clinical strategy to improve the diagnostic accuracy of 1.5-T non-contrast MR coronary angiography for detection of coronary artery disease: combination of whole-heart and volume-targeted imaging

OBJECTIVES

To evaluate the diagnostic performance of 1.5-T non-contrast MR coronary angiography (MRCA) for detection of coronary artery disease (CAD) using whole-heart imaging combined with volume-targeted imaging.

METHODS

Forty-five patients scheduled for conventional coronary angiography (CAG) underwent 1.5-T free-breathing non-contrast steady-state free-precession MRCA, including whole-heart and subsequent three-vessel volume-targeted imaging. Coronary stenosis was evaluated as follows: (1) by whole-heart MRCA alone; (2) by combined MRCA (whole-heart plus volume-targeted images). The diagnostic performance for significant stenosis (≥ 50% diameter reduction) was evaluated and compared using CAG as a reference standard.

RESULTS

Combined MRCA was completed in all 45 patients with a total acquisition time of 16.6 ± 3.3 min. The sensitivity, specificity, and accuracy of combined MRCA per patient were 97% (95% confidence interval 84-100%), 83% (52-98%), and 93% (82-98%), respectively. The areas under the receiver operating characteristic curve of combined MRCA were significantly higher than those of whole-heart MRCA on a per patient (0.97 versus 0.85, p = 0.0078) and per vessel (0.96 versus 0.86, p < 0.0001) basis. Compared with whole-heart MRCA, combined MRCA showed equally high sensitivity but significantly improved specificity on a per patient (83% versus 25%, p = 0.016) and per vessel (85% versus 50%, p < 0.0001) basis.

CONCLUSIONS

1.5-T non-contrast MRCA combining whole-heart and volume-targeted imaging can detect significant CAD with high sensitivity and moderate specificity. Combined MRCA significantly improves specificity compared with whole-heart imaging alone.

KEY POINTS

• 1.5-T non-contrast MRCA with combined whole-heart and volume-targeted imaging can detect CAD with high sensitivity and moderate specificity comparable with coronary CTA. • Compared with whole-heart imaging alone, combined imaging provides improved diagnostic accuracy, especially specificity.

Comparison of compressed sensing and conventional coronary magnetic resonance angiography for detection of coronary artery stenosis

PURPOSE

This study aimed to compare the efficacy of compressed sensing (CS) and conventional coronary magnetic resonance angiography (CMRA) in detecting coronary artery stenosis.

METHOD

Twenty-eight patients underwent 3 T contrast-enhanced CS and conventional CMRA; for late gadolinium enhancement (LGE) imaging, 0.1 mmol/kg gadolinium medium was infused. CS CMRA was scanned within the LGE waiting time. After the LGE image acquisition, conventional CMRA was performed. The diagnostic performance of both CMRA for the detection of significant stenosis was evaluated using coronary angiography as a reference. The analysis was conducted to examine the three main coronary artery vessels: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). These arteries were subdivided into 8 segments (LAD; main, proximal, and middle, LCX; proximal and distal, RCA; proximal, middle, and distal). Of these, hypoplastic segments and vessels after coronary stent implantation were excluded. The acquisition time of CS CMRA was compared with that of conventional CMRA.

RESULTS

The coronary arteries were evaluated in 197 segments. The sensitivity, specificity, and accuracy of CS CMRA in detecting significant stenosis were 85.2 %, 82.5 %, and 83.2 %, respectively, on a per-segment basis. Those of conventional CMRA were 85.2 %, 86.7 %, and 86.3 %, respectively. The acquisition time was 207 s (range, 144-258 s) for CS and 975 s (range, 787-1226s) for conventional CMRA (p < 0.001).

CONCLUSIONS

Similar to conventional CMRA, CS CMRA has shown potential for the detection of significant coronary artery stenosis.

CMR publications from China of the last more than 30 years

Cardiovascular magnetic resonance (CMR) is a non-invasive imaging technology, gradually playing an irreplaceable role in the diagnosis and treatment of cardiovascular diseases. This review demonstrates the progress and research highlights of Chinese CMR publications of the last more than 30 years. At initial stage (1988 to 1997), CMR was introduced to evaluate cardiac anatomy, blood flow and ventricular function roughly in China. In the development stage (1998-2007), CMR began to play an important role in the diagnosis of cardiovascular and pericardial disease with the emergence of new techniques, such as myocardial perfusion imaging and magnetic resonance angiography. Since 2008, the development of CMR in China has reached a prosperous period. Cardiovascular disease can be both qualitatively and quantitatively assessment by CMR "one-stop" multi-parameter imaging, including the morphology, function, myocardial perfusion, tissue characteristics, metabolism and even the microstructure of myocardial fibers, which provides comprehensive assessment of the severity, risk stratification and prognosis of cardiovascular disease. Although CMR in China developed very rapidly in recent years, China still needs to put more efforts in CMR research and make greater contributions to the development of CMR in the world.

Diagnostic Accuracy of Three-Dimensional Whole-Heart Magnetic Resonance Angiography to Detect Coronary Artery Disease with Invasive Coronary Angiography as a Reference: A Meta-Analysis

Objective: We aimed to evaluate the diagnostic performance of three-dimensional whole-heart magnetic resonance coronary angiography (MRCA) in detecting coronary artery disease (CAD) with invasive coronary angiography as the reference standard.Methods: We searched PubMed and Embase for studies evaluating the diagnostic performance of three-dimensional whole-heart MRCA for the diagnosis of CAD with invasive coronary angiography as the reference standard. The bivariate mixed-effects regression model was applied to synthesize available data. The clinical utility of whole-heart MRCA was calculated by the posttest probability based on Bayes’s theorem.Results: Eighteen studies were included, of which 16 provided data at the artery level. Patient-based analysis revealed a pooled sensitivity of 0.90 (95% confidence interval [CI] 0.87‐0.93) and specificity of 0.79 (95% CI 0.73‐0.84), while the pooled estimates were 0.86 (95% CI 0.82‐0.89) and 0.89 (95% CI 0.84‐0.92), respectively, at the artery level. The areas under the summary receiver operating characteristic curve were 0.93 (95% CI 0.90‐0.95) and 0.92 (95% CI 0.90‐0.94) at the patient and artery levels, respectively. With a pretest probability of 50%, the patients’ posttest probabilities of CAD were 81% for positive results and 11% for negative results.Conclusions: Whole-heart MRCA can be an alternative noninvasive method for diagnosis and assessment of CAD.

Three-Dimensional Free-Breathing Whole-Heart Coronary Magnetic Resonance Angiography at 1.5 T: Gadobutrol-Enhanced Gradient-Echo Acquisition Sequence Versus Non-Contrast-Enhanced Steady-State Free Precession Sequence

OBJECTIVES

The objective of this study was to compare gadobutrol-enhanced gradient-echo sequence (GRE) acquisition with T2-prepared non-contrast-enhanced steady-state free precession (SSFP) in coronary magnetic resonance angiography at 1.5 T.

METHODS

Twenty-one subjects successfully completed GRE and SSFP acquisition. Signal-to-noise ratio (SNR), contrast-to-noise ratio, image quality, sharpness, visibility, length, and lumen diameter of vessels were analyzed by 2 experienced radiologists.

RESULTS

The SNR at whole left circumflex artery, left main artery, and proximal left descending artery (LAD) was significantly higher in SSFP acquisition (P < 0.05). The SNR of distal LAD was slightly higher in GRE acquisition (P < 0.05). The contrast-to-noise ratio at distal LAD, proximal and distal RCA were significantly higher with GRE acquisition (P < 0.05).

CONCLUSIONS

Double-dose gadobutrol-enhanced GRE and unenhanced SSFP coronary magnetic resonance angiography at 1.5 T have their own characteristics, and the combined use of the 2 methods may be taken into consideration.

Deep Learning for Quantitative Cardiac MRI

OBJECTIVE. The recent advancement of deep learning techniques has profoundly impacted research on quantitative cardiac MRI analysis. The purpose of this article is to introduce the concept of deep learning, review its current applications on quantitative cardiac MRI, and discuss its limitations and challenges. CONCLUSION. Deep learning has shown state-of-the-art performance on quantitative analysis of multiple cardiac MRI sequences and holds great promise for future use in clinical practice and scientific research.

Diagnostic Accuracy of Noncontrast Self-navigated Free-breathing MR Angiography versus CT Angiography: A Prospective Study in Pediatric Patients with Suspected Anomalous Coronary Arteries

RATIONALE AND OBJECTIVES

To evaluate the diagnostic accuracy of a prototype noncontrast, free-breathing, self-navigated 3D (SN3D) MR angiography (MRA) technique for the assessment of coronary artery anatomy in children with known or suspected coronary anomalies, using CT angiography (CTA) as the reference standard.

MATERIALS AND METHODS

Twenty-one children (15 male, 12.3 ± 2.6 years) were prospectively enrolled between July 2014 and August 2016 in this IRB-approved, HIPAA-compliant study. Patients underwent same-day unenhanced SN3D-MRA and contrast-enhanced CTA. Two observers rated the visualization of coronary artery segments and diagnostic confidence on a 3-point scale and assessed coronary arteries for anomalous origin, as well as interarterial and intramural course. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of SN3D-MRA for the detection of coronary artery abnormalities were calculated. Interobserver agreement was assessed using Intraclass Correlation Coefficients (ICC).

RESULTS

Fourteen children showed coronary artery abnormalities on CTA. The visualization of coronary segments was rated significantly higher for CTA compared to MRA (p <0.015), except for the left main coronary artery (p = 0.301), with good to excellent interobserver agreement (ICC = 0.62-0.94). Diagnostic confidence was higher for CTA (p = 0.046). Sensitivity, specificity, PPV, and NPV of MRA were 92%, 92%, 96%, and 87% for the detection of coronary artery anomalies, 85%, 85%, 74%, and 92% for high origin, 71%, 92%, 82%, and 87% for interarterial, and 41%, 96%, 87%, and 80% for intramural course.

CONCLUSIONS

Noncontrast SN3D-MRA is highly accurate for the detection of coronary artery anomalies in pediatric patients while diagnostic confidence and coronary artery visualization remain superior with CTA.

Hybrid cardiac imaging using PET/MRI: a joint position statement by the European Society of Cardiovascular Radiology (ESCR) and the European Association of Nuclear Medicine (EANM)

Positron emission tomography (PET) and magnetic resonance imaging (MRI) have both been used for decades in cardiovascular imaging. Since 2010, hybrid PET/MRI using sequential and integrated scanner platforms has been available, with hybrid cardiac PET/MR imaging protocols increasingly incorporated into clinical workflows. Given the range of complementary information provided by each method, the use of hybrid PET/MRI may be justified and beneficial in particular clinical settings for the evaluation of different disease entities. In the present joint position statement, we critically review the role and value of integrated PET/MRI in cardiovascular imaging, provide a technical overview of cardiac PET/MRI and practical advice related to the cardiac PET/MRI workflow, identify cardiovascular applications that can potentially benefit from hybrid PET/MRI, and describe the needs for future development and research. In order to encourage its wide dissemination, this article is freely accessible on the European Radiology and European Journal of Hybrid Imaging web sites.

KEY POINTS

• Studies and case-reports indicate that PET/MRI is a feasible and robust technology. • Promising fields of application include a variety of cardiac conditions. • Larger studies are required to demonstrate its incremental and cost-effective value. • The translation of novel radiopharmaceuticals and MR-sequences will provide exciting new opportunities.

Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome

BACKGROUND

Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS.

METHODS

We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation. All medical charts were reviewed to verify accurate prospective data collection and to collect follow-up data.

RESULTS

A total of 391 patients were included. On stress CMR, abnormalities attributable to coronary artery disease (CAD) were found in 106 (27.1%) of patients. Previously undiagnosed moderate to severe valvular disease was the most common non-CAD cardiac finding, occurring in 20 (5.1%) cases. Other alternative diagnoses were rare with 7 cases of cardiomyopathy, 1 case of aortic aneurysm, 1 case of aortic dissection, 1 case of acute myocarditis, 3 cases of pericarditis, and 2 cases of moderate pleural effusion. Cardiac incidental findings were rare. Extracardiac incidental findings were found in 79 patients (20.2%). Only 18.6% of the patients recommended for follow-up imaging had this completed within 1 year after CMR.

CONCLUSIONS

This experience suggests that stress CMR is useful in not only diagnosing symptomatic CAD but also potentially important non-CAD-related disease. These factors may impact their use in ED-based ACS workups.

Additive value of 3T cardiovascular magnetic resonance coronary angiography for detecting coronary artery disease

BACKGROUND

The purpose of the work was to evaluate the incremental diagnostic value of free-breathing, contrast-enhanced, whole-heart, 3 T cardiovascular magnetic resonance coronary angiography (CE-MRCA) to stress/rest myocardial perfusion imaging (MPI) and late gadolinium enhancement (LGE) imaging for detecting coronary artery disease (CAD).

METHODS

Fifty-one patients with suspected CAD underwent a comprehensive cardiovascular magnetic resonance (CMR) examination (CE-MRCA, MPI, and LGE). The additive diagnostic value of MRCA to MPI and LGE was evaluated using invasive x-ray coronary angiography (XA) as the standard for defining functionally significant CAD (≥ 50% stenosis in vessels > 2 mm in diameter).

RESULTS

90.2% (46/51) patients (54.0 ± 11.5 years; 71.7% men) completed CE-MRCA successfully. On per-patient basis, compared to MPI/LGE alone or MPI alone, the addition of MRCA resulted in higher sensitivity (100% vs. 76.5%, p < 0.01), no change in specificity (58.3% vs. 66.7%, p = 0.6), and higher accuracy (89.1% vs 73.9%, p < 0.01) for CAD detection (prevalence = 73.9%). Compared to LGE alone, the addition of CE-MRCA resulted in higher sensitivity (97.1% vs. 41.2%, p < 0.01), inferior specificity (83.3% vs. 91.7%, p = 0.02), and higher diagnostic accuracy (93.5% vs. 54.3%, p < 0.01).

CONCLUSION

The inclusion of successful free-breathing, whole-heart, 3 T CE-MRCA significantly improved the sensitivity and diagnostic accuracy as compared to MPI and LGE alone for CAD detection.

Non-contrast compressed sensing whole-heart coronary magnetic resonance angiography at 3T: A comparison with conventional imaging

OBJECTIVES

Whole-heart coronary magnetic resonance angiography (MRA) is a promising non-contrast, radiation-free technique for assessing the coronary artery. Yet, a disadvantage of coronary MRA is the relatively long acquisition time. The purpose of this study was to evaluate the scan time and image quality of compressed sensing (CS) coronary MRA compared with conventional coronary MRA.

MATERIALS AND METHODS

Twenty healthy volunteers underwent navigator-gated coronary MRA with a CS prototype sequence and conventional navigator-gated coronary MRA on a clinical 3T MRI scanner without contrast medium. The spatial resolutions were 1.33 × 1.33 × 1.20 mm³ for CS and 1.33 × 1.33 × 1.48 mm³ interpolated to 0.70 × 0.70 × 1.20 mm³ for conventional, respectively. We compared acquisition times, rated image quality on a 4-point scale (RCA; proximal, middle, and distal, LAD; main, proximal, middle, and distal, LCX; proximal and distal), and measured the visualized vessel lengths of three vessels.

RESULTS

The mean acceptance rates were 44.9% for CS coronary MRA and 48.7% for conventional coronary MRA (p = .39). The mean effective scan time was 3 min 45 s for CS coronary MRA and 15 min 6 s for conventional coronary MRA (p < 0.001). Image quality scores were significantly lower for CS coronary MRA than for conventional coronary MRA (3.4 ± 0.7 for CS vs. 3.8 ± 0.4 for conventional; p < 0.0001). Conventional coronary MRA images were scored >3.4 in all segments on average, while CS coronary MRA images were scored >3.2 (good quality for diagnosis) in almost all segments, with only the distal RCA segment graded 2.9 on average. The average visible vessel lengths for CS and conventional coronary MRA were as follows: 11.5 ± 4.4 cm and 12.5 ± 4.8 cm for the RCA, respectively (p < 0.05, 95% limits of agreement [LOA]; -3.6 to 1.6 cm); 10.6 ± 3.0 cm and 11.1 ± 2.9 cm for the LAD, respectively (p = .15, 95% LOA -4.0 to 2.8 cm); and 7.1 ± 2.2 cm and 8.2 ± 2.5 cm for the LCX, respectively (p < 0.05, 95% LOA -4.0 to 1.7 cm).

CONCLUSIONS

Non-contrast coronary MRA using CS could largely shorten acquisition time, compared with conventional navigator-gated coronary MRA, while maintaining acceptable visualization at 3T.

Improved respiratory self-navigation for 3D radial acquisitions through the use of a pencil-beam 2D-T2 -prep for free-breathing, whole-heart coronary MRA

PURPOSE

In respiratory self-navigation (SN), signal from static structures, such as the chest wall, may complicate motion detection or introduce post-correction artefacts. Suppressing signal from superfluous tissues may therefore improve image quality. We thus test the hypothesis that SN whole-heart coronary magnetic resonance angiography (MRA) will benefit from an outer-volume suppressing 2D-T2 -Prep and present both phantom and in vivo results.

METHODS

A 2D-T2 -Prep and a conventional T2 -Prep were used prior to a free-breathing 3D-radial SN sequence. Both techniques were compared by imaging a home-built moving cardiac phantom and by performing coronary MRA in nine healthy volunteers. Reconstructions were performed using both a reference-based and a reference-independent approach to motion tracking, along with several coil combinations. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were compared, along with vessel sharpness (VS).

RESULTS

In phantoms, using the 2D-T2 -Prep increased SNR by 16% to 53% and mean VS by 8%; improved motion tracking precision was also achieved. In volunteers, SNR increased by an average of 29% to 33% in the blood pool and by 15% to 25% in the myocardium, depending on the choice of reconstruction coils and algorithm, and VS increased by 34%.

CONCLUSION

A 2D-T2 -Prep significantly improves image quality in both phantoms and volunteers when performing SN coronary MRA. Magn Reson Med 79:1293-1303, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Can visual analogue scale be used in radiologic subjective image quality assessment?

BACKGROUND

Assessment of qualitative or subjective image quality in radiology is traditionally performed using a fixed-point scale even though reproducibility has proved challenging.

OBJECTIVE

Image quality of 3-T coronary magnetic resonance (MR) angiography was evaluated using three scoring methods, hypothesizing that a continuous scoring scale like visual analogue scale would improve the assessment.

MATERIALS AND METHODS

Adolescents corrected for transposition of the great arteries with arterial switch operation, ages 9-15 years (n=12), and healthy, age-matched controls (n=12), were examined with 3-D steady-state free precession magnetic resonance imaging. Image quality of the coronary artery origin was evaluated by using a fixed-point scale (1-4), visual analogue scale of 10 cm and a visual analogue scale with reference points (figurative visual analogue scale). Satisfactory image quality was set to a fixed-point scale 3=visual analogue scale/figurative visual analogue scale 6.6 cm. Statistical analysis was performed using Cohen kappa coefficient and agreement index.

RESULTS

The mean interobserver scores for the fixed-point scale, visual analogue scale and figurative visual analogue scale were, respectively, in the left main stem 2.8, 5.7, 7.0; left anterior descending artery 2.8, 4.7, 6.6; circumflex artery 2.5, 4.5, 6.2, and right coronary artery 3.2, 6.3, 7.7. Scoring with a fixed-point scale gave an intraobserver κ of 0.52-0.77 while interobserver κ was lacking. For visual analogue scale and figurative visual analogue scale, intraobserver agreement indices were, respectively, 0.08-0.58 and 0.43-0.71 and interobserver agreement indices were up to 0.5 and 0.65, respectively.

CONCLUSION

Qualitative image quality evaluation with coronary 3-D steady-state free precession MR angiography, using a visual analogue scale with reference points, had better reproducibility compared to a fixed-point scale and visual analogue scale. Image quality, being a continuum, may be better determined by this method.

Diagnostic performance of image navigated coronary CMR angiography in patients with coronary artery disease

BACKGROUND

The use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD.

METHODS

Consecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings.

RESULTS

Image-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment.

CONCLUSION

In this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

Update on the Role of Cardiac Magnetic Resonance Imaging in Congenital Heart Disease

OPINION STATEMENT

Cardiac magnetic resonance imaging (CMR) is an important imaging modality in the evaluation of congenital heart diseases (CHD). CMR has several strengths including good spatial and temporal resolutions, wide field-of-view, and multi-planar imaging capabilities. CMR provides significant advantages for imaging in CHD through its ability to measure function, flow and vessel sizes, create three-dimensional reconstructions, and perform tissue characterization, all in a single imaging study. Thus, CMR is the most comprehensive imaging modality available today for the evaluation of CHD. Newer MRI sequences and post-processing tools will allow further development of quantitative methods of analysis, and opens the door for risk stratification in CHD. CMR also can interface with computer modeling, 3D printing, and other methods of understanding the complex anatomic and physiologic relationships in CHD.