Free-breathing, non-contrast, 3D whole-heart coronary MRI for the identification of culprit and vulnerable atherosclerotic plaque
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection.
Objectives
To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Methods
41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST.
Results
The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001 respectively). Coronary segments with lipid, calcium and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P=0.05 and P=0.04 respectively).
Conclusions
iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.
Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection.
Objectives
To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
Methods
41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST.
Results
The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001 respectively). Coronary segments with lipid, calcium and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P=0.05 and P=0.04 respectively).
Conclusions
iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.
Date Issued
2025-06-01
Date Acceptance
2025-04-17
Citation
Journal of Cardiovascular Magnetic Resonance, 2025, 27 (1)
ISSN
1097-6647
Publisher
Elsevier BV
Journal / Book Title
Journal of Cardiovascular Magnetic Resonance
Volume
27
Issue
1
Copyright Statement
© 2025 Published by Elsevier.
Identifier
10.1016/j.jocmr.2025.101898
Subjects
Coronary artery disease
atherosclerosis
vulnerable plaque
CMR
Publication Status
Published
Article Number
101898
Date Publish Online
2025-04-02