Combination of free-breathing and breathhold steady-state free precession magnetic resonance angiography for detection of coronary artery stenoses

Purpose: To analyze the incremental diagnostic value of a combination of two approaches (free-breathing and breath-hold) vs. the sole free-breathing approach to coronary magnetic resonance angiography (CMRA) for detection of significant stenoses. Materials and Methods: Thirty patients were consecutively included in this prospective trial. CMRA was performed on a 1.5-T MR scanner (Magnetom Sonata, Siemens) using a balanced steady-state free precession (SSFP) sequence during free-breathing (2.4 x 0.9 x 0.7 mm(3)). Breathholding acquisitions (3.0 x 1.5 x 0.7 mm(3)) were only performed in cases in which the quality of free-breatbing CMRA precluded assessment. Patients with contraindications to CMRA, claustrophobia, or nonassessable images were not excluded from the assessment of diagnostic accuracy (intention-to-diagnose design). Results: In 60% of all free-breathing coronary acquisitions the image quality was adequate for diagnostic assessment. For the remaining 40% of the cases, breathhold acquisitions were obtained. The sensitivity, specificity, nonassessable rate, and accuracy in identifying main coronary branches with significant stenoses using the combination of both breathing approaches and the free-breathing approach alone were 65% vs. 32%, 73% vs. 53%, 24% vs. 52%, and 71 % vs. 46%, respectively (P < 0.001). Conclusion: In this consecutive cohort of patients. the combination of free-breathing and breathhold CMRA significantly improved diagnostic accuracy. Nevertheless, even this combination did not reach accuracies sufficient for routine clinical application.