Simultaneous bright- and black-blood three-dimensional whole-heart magnetic resonance imaging for integrated coronary plaque detection and luminal stenosis assessment: A prospective comparison with coronary computed tomography angiography.

BACKGROUND: Coronary computed tomographic angiography (CCTA) is a first-line test for anatomical evaluation of the coronary arteries in stable chest pain. Despite technical advances, CCTA requires breath hold and exposes patients to ionizing radiation and contrast agents. Coronary cardiovascular magnetic resonance angiography (CCMRA) has been limited by long and unpredictable scan times, lower spatial resolution, and restricted plaque characterization. We developed a novel cardiovascular magnetic resonance sequence, Bright-blood and black-blood phase SensiTive (BOOST) sequence, which produces a co-registered bright-blood image for lumen visualization and a T1-weighted black-blood image for vessel wall and plaque assessment from a single scan with predictable scan times.

OBJECTIVES: To compare the BOOST-CCMRA sequence with CCTA for plaque characterization and stenosis evaluation in patients with stable chest pain.

METHODS: Sixty consecutive patients (mean age 56 years, 60% (36/60) male) with stable chest pain were prospectively enrolled. All underwent CCTA followed by BOOST-CCMRA on a 1.5T magnetic resonance imaging scanner. Coronary plaques identified on CCTA were analyzed on the black-blood BOOST image using the signal from plaque to derive the plaque-to-myocardium ratio (PMR); a healthy vessel-to-myocardium ratio (HVMR) was derived as reference. Plaque morphology was assessed by CCTA appearance. Luminal stenosis was assessed on BOOST bright-blood images and compared with CCTA.

RESULTS: Of 60 patients, 35 had plaque on CCTA, with 72 plaques identified. 9 plaques were not detected on BOOST, giving an 88% (63/72) detection success. BOOST showed agreement with CCTA in stenosis grading for 51 of 63 lesions (81%): 23/26 (88%) minimal, 20/24 (83%) mild, 4/7 (57%) moderate, 3/5 (60%) severe, and 1/1 (100%) occlusion. PMR was significantly higher than HVMR (0.64 ± 0.16 vs 0.36 ± 0.11; p < 0.001) across all plaque subtypes (calcified 0.53 ± 0.11, partially calcified 0.70 ± 0.15, non-calcified 0.69 ± 0.16, all p < 0.001 vs HVMR). Hypertension and family history of premature cardiovascular disease were associated with higher PMR values.

CONCLUSION: The BOOST sequence allows simultaneous evaluation of coronary lumen and plaque characteristics in a single non-contrast CCMRA acquisition, with reliable plaque identification and good agreement with CCTA for stenosis severity assessment. This approach may offer free-breathing alternative, without radiation or contrast, for integrated anatomical and plaque imaging in patients with stable chest pain.