Coronary artery magnetic resonance angiography using steady-state free precession imaging

X-ray angiography is currently the gold standard for evaluating coronary artery disease (CAD). It is an invasive procedure with risks of developing potentially serious complications. Exposure to ionizing radiation is also a concern. A non-invasive alternative to image the coronary arteries without any harmful radiation is Magnetic Resonance Imaging (MRI). A major advantage of MRI is that it can provide functional information of the heart in addition to the anatomic information.; The purpose of this work was to develop a magnetization-prepared, segmented, breath-hold, three-dimensional trueFISP (Fast Imaging with Steady-state Precession) pulse sequence for coronary artery imaging. The goal was to improve the achievable signal-to-noise ratio (SNR) and blood-myocardial contrast-to-noise ratio (CNR) over the currently used method for coronary magnetic resonance angiography (MRA), fast low angle shot (FLASH). To achieve fat suppression and minimal field inhomogeneity induced image artifacts, a spectrally selective excitation and a half flip angle pulse with preparation cycles were used, respectively. Three different strategies were proposed to reduce the sensitivity of trueFISP to field inhomogeneities—asymmetric sampling, linear flip angle magnetization preparation, and adjustment of the imaging frequency. Numerical simulations, phantom studies, and volunteer studies were performed to compare the trueFISP method to FLASH. Results showed that fat suppressed images without any significant image artifacts could be acquired with trueFISP. Considerably higher SNR and CNR were observed with trueFISP as compared to FLASH.; To enhance the blood-background CNR further, the role of contrast agents in trueFISP imaging was examined. A magnetization preparation was designed to achieve myocardial and fat suppression simultaneously using inversion recovery. Numerical simulations, phantom studies, and volunteer studies showed that the fat suppression was improved and the blood-background CNR was increased substantially.; Finally, the non-contrast trueFISP sequence was implemented in a clinical setting and patient studies were conducted to evaluate efficacy of the technique in detecting CAD. Results showed that trueFISP had a high sensitivity and negative predictive value in detecting coronary artery disease. In conclusion, trueFISP is a promising technique for coronary MRA and is likely to have a future role in clinical evaluation of CAD.