Can Cardiac MRI Detect Coronic Artery Disease?

Cardiac MRI serves as a valuable tool in assessing coronary artery disease (CAD), though it is not considered the gold standard for diagnosis. The definitive diagnosis of CAD typically relies on coronary angiography or coronary CT angiography, both of which provide clear visualization of any narrowing in the coronary arteries. However, cardiac MRI plays a significant role in evaluating myocardial function and detecting tissue abnormalities associated with CAD.

How Cardiac MRI Assesses Coronary Artery Disease

Cardiac MRI utilizes specific imaging sequences, including resting first-pass perfusion and late gadolinium enhancement (LGE) imaging. Resting perfusion MRI can identify areas of reduced blood flow, known as perfusion defects, which often indicate significant coronary artery stenosis. These findings are particularly useful in patients who are unable to undergo stress testing due to physical limitations.

Understanding Late Gadolinium Enhancement

Late gadolinium enhancement is a powerful technique used to identify areas of myocardial scarring or necrosis. This method reveals distinct patterns that help differentiate ischemic damage from other forms of cardiomyopathy. Two key characteristics of LGE in CAD include:

Transmural progression: Enhancement typically begins at the endocardium and extends toward the epicardium, reflecting the pattern of ischemic injury.
Coronary territory alignment: The location of the scar corresponds precisely with the distribution of a specific coronary artery, supporting the diagnosis of CAD-related damage.

The Clinical Value of Cardiac MRI in CAD

These imaging features make cardiac MRI an essential tool in the clinical evaluation of CAD. Beyond diagnosis, it is increasingly used to assess prognosis, guide treatment decisions, and monitor disease progression. By accurately identifying areas of myocardial damage and correlating them with coronary anatomy, cardiac MRI provides critical insights into patient management and risk stratification.