Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque

Reza Hajhosseiny; Adam Hartley; Graham Cole; Camilla Munoz; Amarjit Sethi; Rasha Al-Lamee; Saud Khawaja; Sameer Zaman; James Howard; Deepa Gopalan; null Ben Ariff; Raffi Kaprielian; Radhouene Neji; Karl P Kunze; Amit Kaura; Claudia Prieto; Ramzi Khamis; René M Botnar

doi:10.1016/j.jocmr.2025.101898

Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque

Reza Hajhosseiny, Adam Hartley, Graham Cole, Camilla Munoz, Amarjit Sethi, Rasha Al-Lamee, Saud Khawaja, Sameer Zaman, James Howard, Deepa Gopalan, Ben Ariff, Raffi Kaprielian, Radhouene Neji, Karl P Kunze, Amit Kaura, Claudia Prieto, Ramzi Khamis, René M Botnar

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Abstract

Background: Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection. Objectives: To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: 41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST. Results: The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P = 0.05 and P = 0.04, respectively). Conclusion: iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.

Original language	English
Article number	101898
Pages (from-to)	101898
Journal	Journal of Cardiovascular Magnetic Resonance
Volume	27
Issue number	1
Early online date	22 Apr 2025
DOIs	https://doi.org/10.1016/j.jocmr.2025.101898
Publication status	Published - 1 Jun 2025

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Hajhosseiny, R., Hartley, A., Cole, G., Munoz, C., Sethi, A., Al-Lamee, R., Khawaja, S., Zaman, S., Howard, J., Gopalan, D., Ben Ariff, Kaprielian, R., Neji, R., Kunze, K. P., Kaura, A., Prieto, C., Khamis, R., & Botnar, R. M. (2025). Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque. Journal of Cardiovascular Magnetic Resonance, 27(1), 101898. Article 101898. https://doi.org/10.1016/j.jocmr.2025.101898

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title = "Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque",

abstract = "Background: Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection. Objectives: To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: 41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST. Results: The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P = 0.05 and P = 0.04, respectively). Conclusion: iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.",

author = "Reza Hajhosseiny and Adam Hartley and Graham Cole and Camilla Munoz and Amarjit Sethi and Rasha Al-Lamee and Saud Khawaja and Sameer Zaman and James Howard and Deepa Gopalan and {Ben Ariff} and Raffi Kaprielian and Radhouene Neji and Kunze, {Karl P} and Amit Kaura and Claudia Prieto and Ramzi Khamis and Botnar, {Ren{\'e} M}",

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day = "1",

doi = "10.1016/j.jocmr.2025.101898",

language = "English",

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Hajhosseiny, R, Hartley, A, Cole, G, Munoz, C, Sethi, A, Al-Lamee, R, Khawaja, S, Zaman, S, Howard, J, Gopalan, D, Ben Ariff, Kaprielian, R, Neji, R, Kunze, KP, Kaura, A, Prieto, C, Khamis, R & Botnar, RM 2025, 'Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque', Journal of Cardiovascular Magnetic Resonance, vol. 27, no. 1, 101898, pp. 101898. https://doi.org/10.1016/j.jocmr.2025.101898

Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque. / Hajhosseiny, Reza; Hartley, Adam; Cole, Graham et al.
In: Journal of Cardiovascular Magnetic Resonance, Vol. 27, No. 1, 101898, 01.06.2025, p. 101898.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque

AU - Hajhosseiny, Reza

AU - Hartley, Adam

AU - Cole, Graham

AU - Munoz, Camilla

AU - Sethi, Amarjit

AU - Al-Lamee, Rasha

AU - Khawaja, Saud

AU - Zaman, Sameer

AU - Howard, James

AU - Gopalan, Deepa

AU - Ben Ariff, null

AU - Kaprielian, Raffi

AU - Neji, Radhouene

AU - Kunze, Karl P

AU - Kaura, Amit

AU - Prieto, Claudia

AU - Khamis, Ramzi

AU - Botnar, René M

PY - 2025/6/1

Y1 - 2025/6/1

N2 - Background: Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection. Objectives: To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: 41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST. Results: The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P = 0.05 and P = 0.04, respectively). Conclusion: iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.

AB - Background: Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection. Objectives: To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: 41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST. Results: The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001, respectively). Coronary segments with lipid, calcium, and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P = 0.05 and P = 0.04, respectively). Conclusion: iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.

UR - http://www.scopus.com/inward/record.url?scp=105004309344&partnerID=8YFLogxK

U2 - 10.1016/j.jocmr.2025.101898

DO - 10.1016/j.jocmr.2025.101898

M3 - Article

C2 - 40274104

SN - 1097-6647

VL - 27

SP - 101898

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

IS - 1

M1 - 101898

ER -

Free-breathing, non-contrast, three-dimensional whole-heart coronary magnetic resonance imaging for the identification of culprit and vulnerable atherosclerotic plaque

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