A major question, given the cost constraints for a potential interested party, is which technique—MRI or EBT—should one purchase?

This largely depends on the purpose for which the technique will be used. If one is interested in visualising coronary arteries or venous bypass grafts EBT seems more robust than MRI.

Visualisation of the heart chambers and cardiac masses can be achieved equally effectively by both techniques. MRI is superior for studying left ventricular function and perfusion, and obviously flow can only be determined by MRI (although it is still in its early phase of development).

Figure 32.8. Example of coronary calcification score. Blue dots in the left anterior descending artery represent calcification.

1. van Geuns RJ, Wielopolski PA, de Bruin HG, et al.

Basic principles of magnetic resonance imaging. Prog Cardiovasc Dis 1999;42:149-56.

• The basic principles of MRI are presented in a simplified schematic approach.

2. van Geuns RJ, Wielopolski PA, de Bruin HG, et al.

Magnetic resonance imaging of the coronary arteries: techniques and results. Prog Cardiovasc Dis 1999;42:157-66.

• The basic concepts, clinical results, possibilities, and limitations of MR coronary angiography are reviewed.

3. Brown MA, Semelka RC. MR imaging abbreviations, definitions, and descriptions: a review. Radiology 1999;213:647-62.

4. European Society of Cardiology/Association of European Paediatric Cardiologists. The clinical role of magnetic resonance in cardiovascular disease. Task Force of the European Society of Cardiology, in collaboration with the Association of European Paediatric Cardiologists. Eur Heart J 1998;19:19-39.

• The clinical role ofMRI in cardiovasculardisease is highlighted and general recommendations are given about the explicit role of MRI in the diagnosis of cardiovascular disease, taking into account other existing diagnostic tools. This article is highly recommended.

5. Wielopolski PA, van Geuns RJM, de Feyter PJ, et al.

Review article: coronary arteries. Eur Radiology 2000;10:12-35.

• This article presents the current state of art of MRI for diagnosis of cardiovascular disease.

6. Manning WJ, Li W, Edelman RR. A preliminary report comparing magnetic resonance coronary angiography with conventional angiography. N Engl J Med 1993;328:828-32.

• This is the first report showing a rather high sensitivity and specificity of MR coronary angiography in patients.

7. Wielopolski PA, van Geuns RJ, de Feyter PJ, et al.

Breath-hold coronary MR angiography with volume-targeted imaging. Radiology 1998;209:209-19.

8. Post JC, van Rossum AC, Bronzwaer JG, et al.

Magnetic resonance angiography of anomalous coronary arteries. A new gold standard for delineating the proximal course? Circulation 1995;92:3163-71.

9. van der Geest RJ, Reiber JH. Quantification in cardiac MRI. JMagn Reson Imaging 1999;10:602-8.

10. van Rugge FP, van der Wall EE, Spanjersberg SJ, et al. Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease. Quantitative wall motion analysis using a modification of the centerline method. Circulation 1994;90:127-38.

11. Hundley WG, Hamilton CA, Thomas MS, et al. Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography Circulation 1999;100:1697-702.

12. Baer FM, Theissen P, Schneider CA, et al.

Dobutamine magnetic resonance imaging predicts contractile recovery of chronically dysfunctional myocardium after successful revascularization. JAm Coll Cardiol 1998;31:1040-8.

13. Geskin G, Kramer CM, Rogers WJ, et al. Quantitative assessment of myocardial viability after infarction by dobutamine magnetic resonance tagging. Circulation 1998;98:217-23.

14. Saeed M, Wendland MF, Yu KK, et al. Identification of myocardial reperfusion with echo planar magnetic resonance imaging. Discrimination between occlusive and reperfused infarctions. Circulation 1994;90:1492-501.

15. Wu KC, Zerhouni EA, Judd RM, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97:765-72.

16. Hoffmann U, Globits S, Frank H. Cardiac and paracardiac masses. Current opinion on diagnostic evaluation by magnetic resonance imaging. EurHeart J 1998;19:553-63.

17. Rensing BJ, Bongaerts AH, van Geuns RJ, et al.

Intravenous coronary angiography using electron beam computed tomography. Prog Cardiovasc Dis 1999;42:139-48.

• This excellent review describes the technique and summarises the studies with EBT regarding both the visualisation of venous bypass grafts and coronary arteries and the diagnostic value in detecting significant obstructions.

18. Rensing BJ, Bongaerts A, van Geuns RJ, et al.

Intravenous coronary angiography by electron beam computed tomography: a clinical evaluation. Circulation 1998;98:2509-12.

19. Moshage WE, Achenbach S, Seese B, et al. Coronary artery stenoses: three-dimensional imaging with electrocardiographically triggered, contrast agent-enhanced, electron-beam CT. Radiology 1995;196:707-14.

• This is the first report about the clinical results of visualising the coronary arteries with contrast enhanced electron beam tomography.

20. Agatston AS, Janowitz WR, Hildner FJ, et al.

Quantification of coronary artery calcium using ultrafast computed tomography. JAm Coll Cardiol 1990;15:827-32.

21. Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association writing group. Circulation 1996;94:1175-92.

• This is a thorough review of a committee of the American Heart Association about the pathophysiology ofcoronary calcium, the role and place of EBT to detect and quantify calcium, its relation to extent and severity of coronary atherosclerosis, and its prognostic value.

22. Rumberger JA, Brundage BH, Rader DJ, et al.

Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 1999;74:243-52.

• A critical review regarding EBT coronary calcium scanning from a clinical perspective: calcium as a measure of atherosclerosis, or as a prognostic indicator of cardiac events. Interpretation guidelines are offered to help guide initiation of a clinically active programme in high risk individuals.


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