For example, several studies on outpatients with suspected CAD (eg, MR-IMPACT, CE-MARC, MR-INFORM) demonstrated superior performance of stress CMR when compared with nuclear SPECT MPI [119,120] and have recently reported noninferiority when compared with invasive FFR [121]. MRI Heart Function and Morphology MRI Heart Function and Morphology CMR with delayed postcontrast imaging and edema-weighted imaging provides assessment of the size, distribution, and transmural extent of acute or remote MI. Cine CMR has usefulness in demonstrating wall-motion abnormalities, which may accompany acute or chronic ischemic heart disease, and first-pass contrast-enhanced perfusion CMR can demonstrate myocardial perfusion abnormalities [110,111,122-124]. The use of T2-weighted CMR to identify myocardial edema can help predict outcomes in patients with NSTE-ACS without affecting time to catheterization [125]. In addition, CMR has a role in elucidating the cause of myocardial necrosis in patients with elevated cardiac biomarkers presumed to have ACS but with nonobstructive coronary arteries by CT or catheter angiography [126,127]. MRI, like CT, can also identify noncardiac reasons for chest pain. Both contrast-enhanced and nonenhanced time-of-flight angiographic techniques can be used for aortic pathology, and CMR can be used for the evaluation of other mimics of ACS with troponin elevation, including pericarditis, myocarditis, and Takotsubo cardiomyopathy [128,129]. New techniques in CMR, for example, myocardial mapping, may provide additional methods that can be used to evaluate patients with acute chest pain [130,131]. MRA Coronary Arteries Although coronary MR angiography (MRA) has not been established in general practice, both angiographic and phase-contrast flow continue to be developed for coronary artery assessment in research centers [132].
Chest Pain Possible Acute Coronary Syndrome PCAs. For example, several studies on outpatients with suspected CAD (eg, MR-IMPACT, CE-MARC, MR-INFORM) demonstrated superior performance of stress CMR when compared with nuclear SPECT MPI [119,120] and have recently reported noninferiority when compared with invasive FFR [121]. MRI Heart Function and Morphology MRI Heart Function and Morphology CMR with delayed postcontrast imaging and edema-weighted imaging provides assessment of the size, distribution, and transmural extent of acute or remote MI. Cine CMR has usefulness in demonstrating wall-motion abnormalities, which may accompany acute or chronic ischemic heart disease, and first-pass contrast-enhanced perfusion CMR can demonstrate myocardial perfusion abnormalities [110,111,122-124]. The use of T2-weighted CMR to identify myocardial edema can help predict outcomes in patients with NSTE-ACS without affecting time to catheterization [125]. In addition, CMR has a role in elucidating the cause of myocardial necrosis in patients with elevated cardiac biomarkers presumed to have ACS but with nonobstructive coronary arteries by CT or catheter angiography [126,127]. MRI, like CT, can also identify noncardiac reasons for chest pain. Both contrast-enhanced and nonenhanced time-of-flight angiographic techniques can be used for aortic pathology, and CMR can be used for the evaluation of other mimics of ACS with troponin elevation, including pericarditis, myocarditis, and Takotsubo cardiomyopathy [128,129]. New techniques in CMR, for example, myocardial mapping, may provide additional methods that can be used to evaluate patients with acute chest pain [130,131]. MRA Coronary Arteries Although coronary MR angiography (MRA) has not been established in general practice, both angiographic and phase-contrast flow continue to be developed for coronary artery assessment in research centers [132].