Coronary artery disease (CAD) is the leading cause of death in the United States, responsible for an estimated 900,000 deaths per year. With the addition of 1.5 million heart attacks annually, the estimated cost in the United States alone exceeds $60 billion.<sup>28 Heart and Stroke Facts. 1996 Statistical Supplement Dallas, TX: American Heart Association (1996). 

Cliccare qui per andare alla sezione Riferimenti</sup> Currently, more than 1 million diagnostic cardiac catheterizations are performed annually to define coronary artery anatomy and guide therapy for cardiac patients.<sup>38 Johnson L.W., Lozner E.C., Johnson S. , e al. Coronary arteriography 1984–1987: A report of the Registry of the Society for Cardiac Angiography and Interventions: I. Results and complications Cathet Cardiovasc Diagn 1989 ;  17 : 5-10  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Although angiographic visual estimation of the severity of coronary lesions has considerable interobserver variability,<sup>43 Legrand V., Raskinet B., Martinez C. , e al. Variability in estimation of coronary dimensions from 6F and 8F catheters Cathet Cardiovasc Diagn 1996 ;  37 : 39-45  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> x-ray contrast angiography is widely accepted as the definitive method to define coronary anatomy. This procedure, however, is associated with significant radiation exposure to both patient and physician and carries a small (1.7%) risk for potentially serious complications.<sup>38 Johnson L.W., Lozner E.C., Johnson S. , e al. Coronary arteriography 1984–1987: A report of the Registry of the Society for Cardiac Angiography and Interventions: I. Results and complications Cathet Cardiovasc Diagn 1989 ;  17 : 5-10  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Additionally the procedural cost of $3000 to $5000 is now becoming a limiting factor in an era of increased cost containment. Finally, x-ray angiography provides little information regarding coronary artery blood flow, frequently necessitating a second test (such as stress testing) to assess the functional significance of coronary lesions.

An alternative, noninvasive technique that could reliably provide both anatomic and functional information about the coronary circulation would represent an important advance in diagnostic cardiology. Transthoracic<sup>84 Sawada S.G., Ryan T., Segar D. , e al. Distinguishing ischemic cardiomyopathy from nonischemic dilated cardiomyopathy with coronary echocardiography J Am Coll Cardiol 1992 ;  19 : 1223-1228  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and transesophageal<sup>107 Yoshida K., Yoshikawa J., Hozumi T. , e al. Detection of left main coronary artery stenosis by transesophageal color Doppler and two-dimensional echocardiography Circulation 1990 ;  81 : 1271-1276  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> echocardiography and computed tomography<sup>39 Kaufmann R.B., Peyser P.A., Sheedy P.F. , e al. Quantification of coronary artery calcium by electron beam computed tomography for determination of severity of angiographic coronary artery disease in younger patients J Am Coll Cardiol 1995 ;  25 : 626-632  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 58 Moshage W.E., Achenbach S., Seese B. , e al. Coronary artery stenoses: Three-dimensional imaging with electrocardiographically triggered, contrast agent–enhanced, electron-beam CT Radiology 1995 ;  196 : 707-714

Cliccare qui per andare alla sezione Riferimenti</sup> all had limited success in adequately defining both anatomy and function of the coronary circulation. Additionally, stress testing with echocardiographic or nuclear perfusion imaging and positron-emission tomography (PET) are inherently not suitable for anatomic evaluation of the coronary arteries. Aortic and peripheral artery magnetic resonance (MR) angiography has an established role in the noninvasive diagnostic evaluation of the circulatory system. More recently, coronary MR angiography has made possible the visualization of the major epicardial coronary vessels. It has also allowed for noninvasive assessment of absolute coronary blood flow and flow reserve. Finally, coronary MR angiography can be readily combined with anatomic and functional imaging of both the left and right ventricles for a comprehensive cardiac examination, thereby maximizing the cost-to-benefit ratio and minimizing patient discomfort and risk. This article reviews the current status and future perspectives of coronary MR angiography.