Magnetic resonance coronary angiography in the era of multimodality imaging

Abstract

Cardiovascular magnetic resonance is currently the reference standard for non-invasive measurements of ventricular dimensions and ejection fraction, and may offer a comprehensive assessment of all myocardial tissue properties (including oedema, fibrosis, fat, iron, and protein deposition), as well as of stress perfusion, conveniently as part of a single examination. It also has a well-established role for coronary assessment in paediatric patients, especially with congenital heart disease and vasculitides, such as Kawasaki disease, and it should be considered as a first-line technique in these cases. Despite being recognised as a safe, non-radiating, and non-contrast technique, it is yet to be implemented widely in clinical use as an efficient alternative to computed tomography coronary angiography. Currently impressive progress is being made in the development of sequences and overcoming technical challenges, which are thoroughly discussed in this article, while further development is required to convert this into a robust, non-invasive technique for routine clinical decision-making in cardiovascular disease, particularly in adult patients. In this review, we will summarise current clinical applications of magnetic resonance coronary imaging, both in adult and paediatric populations, with reference to currently established imaging techniques, focusing also on ongoing research and future development.