Cardiovascular magnetic resonance evaluation of the patient with known or suspected coronary artery disease

Cardiovascular magnetic resonance (CMR) imaging is finding an increasing role in the diagnosis of cardiac disease. In many instances, CMR provides valuable information and for some aspects, such as left ventricular function, is considered to be the diagnostic ‘gold standard’.1 Among the most important advances is the implementation of balanced steady state free precession (SSFP) sequences that provide higher signal-to-noise ratio than can be obtained by conventional gradient echo techniques, along with excellent delineation of the blood–myocardium interface. The SSFP technique has become the preferred cardiac CMR pulse sequence for acquisition of volumetric datasets of the left and right ventricle. Parallel acquisition techniques allow image acquisition times to be substantially shortened. Next to imaging of cardiac morphology CMR has several distinct applications that are of use in assessing patients with chest pain. First of all, CMR is currently considered the gold standard for quantification of ventricular volumes, biventricular global and regional function, and mass.1 Even small motion abnormalities can be reliably detected due to free choice of tomographic plane, high spatial resolution, as well as excellent delineation of endo- and epicardial borders (figure 1). Compared to echocardiography, CMR provides more precise data and is associated with lower interobserver and interstudy variability. For stress testing, this can be of particular advantage and improved accuracy of stress CMR over echocardiography has been demonstrated in patients with poor echocardiographic windows2 (figure 2). Of major interest is the ability of CMR to visualise myocardial scar directly by using a segmented inversion recovery gradient echo sequence at least 10 min after the intravenous injection of gadolinium contrast (figure 1). This method, termed ‘delayed gadolinium enhancement-CMR’ (DGE-CMR), unmasks non-viable, irreversibly damaged myocardium as a hyperenhanced or ‘bright’ area in a manner that closely correlates to histopathology findings.3 Compared to nuclear imaging, CMR …