Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging

Purpose: To evaluate the feasibility and accuracy of magnetic resonance (MR) coronary angiography for the detection of coronary artery anomalies in infants and children by using surgical findings as a reference. Materials and Methods: The data analysis was approved by the institutional review board. One hundred children with congenital heart disease underwent MR coronary angiography while under general anesthesia (mean age ± standard deviation, 3.9 years ± 3; age range, 0.2-11 years). A navigator-gated, T2-prepared, three-dimensional steady-state free precession whole-heart protocol (isotropic voxel size, 1.0-1.3 mm³; mean imaging time, 4.6 minutes ± 1.2; mean navigator efficiency, 70%; 3-mm gating window) was used after injection of gadopentetate dimeglumine. The cardiac rest period (end systole or middiastole) and acquisition window were prospectively assessed for each patient. Coronary artery image quality (score of 0 [nondiagnostic] to 4 [excellent]), vessel sharpness, and coronary artery anomalies were assessed by two observers. Surgery was performed in 58 patients, and those findings were used to define accuracy. Variables were assessed between age groups by using either analysis of variance or Kruskal-Wallis tests. Results: Diagnostic image quality (score, ≥1 for all coronary artery segments) was obtained in 46 of the 58 patients (79%) who underwent surgery. The origin and course of the coronary artery anatomy depicted with MR imaging was confirmed at surgery in all 46 patients - including the four (9%) with substantial coronary artery anomalies. Diagnostic-quality images were obtained in 84 of the 100 patients. The rate of success improved significantly when patients were older than 4 months (88% for patients >4 months vs 17% for patients ≤4 months, P < .001). Conclusion: Improved whole-heart MR coronary angiography enables accurate detection of abnormal origin and course of the coronary artery system even in very young patients with congenital heart disease.