The Role of MRI for Diagnosis in Women with Angina and Open Arteries

Abstract

Magnetic resonance imaging (MRI) may be used for evaluation of women with angina and open coronary arteries. Magnetic resonance spectroscopy (MRS) is a unique noninvasive molecular imaging tool for characterization of cellular metabolites such as adenosine triphosphate and phosphocreatine. Multiple studies spanning more than a decade have provided evidence of biochemical changes due to myocardial ischemia in women who have angina without epicardial stenosis. Advances in perfusion imaging allow visualization of the first pass of contrast in the myocardium for detection of perfusion defects provoked by stress testing within the magnet. Having been validated for detection of epicardial coronary artery disease, this technique has also been used in patients with microvascular disease. The combination of rest and stress first pass imaging permits measurement of the myocardial perfusion reserve, calculated from the ratio of the normalized upslope of the time intensity curves during first pass of gadolinium based contrast. Quantitative approaches are likely to be particularly important for non invasive detection of diffuse microvascular coronary dysfunction. This chapter describes these different MRI techniques with examples of studies that have used this imaging method for non invasive evaluation of women with angina and open arteries.