Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque

• Published in: Journal of cardiovascular magnetic resonance Vol. 27; no. 1; p. 101898
• Main Authors: Hajhosseiny, Reza, Hartley, Adam, Cole, Graham, Munoz, Camilla, Sethi, Amarjit, Al-Lamee, Rasha, Khawaja, Saud, Zaman, Sameer, Howard, James, Gopalan, Deepa, Ariff, Ben, Kaprielian, Raffi, Neji, Radhouene, Kunze, Karl P., Kaura, Amit, Prieto, Claudia, Khamis, Ramzi, Botnar, René M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2025; Elsevier
• Subjects: Aged; Atherosclerosis; CMR; Coronary Angiography; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - pathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Female; Humans; Image Interpretation, Computer-Assisted - methods; Imaging, Three-Dimensional - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Non-ST Elevated Myocardial Infarction - diagnostic imaging; Non-ST Elevated Myocardial Infarction - etiology; Non-ST Elevated Myocardial Infarction - pathology; Original Research; Plaque, Atherosclerotic; Predictive Value of Tests; Reproducibility of Results; Respiration; Rupture, Spontaneous; Vulnerable plaque; NSTEMI; OCT; FH; MRI; LR; bSSFP; LVEF; iNAV; SSFP; TCFA; HDL; SD; CCTA; 2D; Vulnerable plaque; ANOVA; LDL; 18F-NaF; SI; Atherosclerosis; T1W; HbA1c; eGFR; LCx; PROST; CAD; ECG; CMR; IR; IVUS; FOV; Coronary artery disease; LAD; T2-prep; ACS; RCA; TE; 3D; LMS; PMR; PCI; FHx; SEM; HD; SENSE; PET; TR
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1016/j.jocmr.2025.101898

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. To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). 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. 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). 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. [Display omitted]