Coronary Anomalies Assessed by Whole-Heart Isotropic 3D Magnetic Resonance Imaging for Cardiac Morphology in Congenital Heart Disease

Purpose: To determine the value of whole-heart three-dimensional magnetic resonance imaging (MRI) for coronary artery imaging in children/adolescents with congenital heart disease (CHD). Materials and Methods: Forty children/adolescents (median age: 14 years, range 2.6-25.8) with CHID underwent free-breathing navigator-gated isotropic three-dimensional steady-state free-precession (3D-SSFP) MRI for cardiac morphology. Two observers independently evaluated visibility of origin, course, vessel lengths, image quality (IQ), and contrast between coronary lumen and myocardium. A subgroup was compared with cardiac catheter. Results: The total scan time was 6.3 +/- 3.2 minutes (mean +/- SD, at mean heart rate 76 +/- 15/min). The mean vessel length for right coronary artery (RCA) by observer 1 was 97 +/- 43 mm (observer 2: 94 +/- 37 mm), for left main and anterior descending artery (LM/LAD) 91 +/- 40 mm (observer 2: 90 +/- 40 mm), and for left circumflex artery (LCX) 64 +/- 28 mm (observer 2: 66 +/- 28 mm). The mean vessel contrast was 0.34 +/- 0.05 (range: 0.23-0.45: maximum = 1, minimum = 0). On a 4-level score (1 = nondiagnostic, 4 = excellent), mean IQ scores ranged between 2.3-2.9 ( +/-0.8-1.0). Both observers agreed on the presence/ proximal course of RCA in 40/40, LM/LAD in 38/40. and LCX in 36/40 patients. There was complete agreement with invasive coronary angiography available in 12/40 patients (six anomalies). Conclusion: Isotropic whole-heart 3D-MRI for cardiac morphology allows reliable discrimination between normal and abnormal coronary anatomy in children/adolescents with CHID.