Registro Nacional Argentino de Resonancia Cardíaca (RENAREC) / Argentine National Cardiac Magnetic Resonance Imaging Registry (RENAREC)

RESUMEN Introducción: La utilidad de la resonancia magnética cardíaca (RMC) ha crecido ampliamente en los últimos años, en los cuales se han publicado distintos registros internacionales sobre su uso e impacto clínico. Sin embargo, no contamos con este tipo de información en Argentina. Objetivo: Evaluar indicaciones, protocolos utilizados, seguridad y consecuencias terapéuticas de la RMC en la República Argentina. Material y métodos: Se diseñó un registro prospectivo a nivel nacional con recolección de datos demográficos, indicaciones de RMC, complicaciones asociadas, diagnósticos y consecuencias terapéuticas. Resultados: Participaron 34 centros de 10 provincias de Argentina (85% centros privados, 59% centros con internación). Se incluyeron 1131 pacientes (edad 54 ± 18 años, 61% varones). Las principales indicaciones para el estudio de RMC fueron la miocardiopatía hipertrófica (13,9%) y la arritmia ventricular (12,3%). El 99,7% de los estudios fueron reportados sin complicaciones. Los resultados más frecuentes de la RMC fueron: normal (31,2%), miocardiopatía no isquémica (14,7%), miocardiopatía isquémico-necrótica (11,6%) y miocardiopatía hipertrófica (8,9%). La sospecha clínica fue confirmada en el 23,6% de los casos y la RMC generó un diagnóstico nuevo no sospechado en el 48,7% de los casos. Las consecuencias terapéuticas más frecuentes fueron el alta hospitalaria (31,6%) seguida por el cambio en la medicación (28,1%). Conclusiones: La RMC es un estudio ampliamente utilizado en Argentina, principalmente en centros privados, con un número muy bajo de complicaciones. Las principales indicaciones son las miocardiopatías (hipertrófica y dilatada) y la arritmia ventricular, y provee un diagnóstico nuevo no sospechado en casi la mitad de los casos. Se requieren de otros estudios en el futuro para evaluar las implicancias clínicas y terapéuticas.

ABSTRACT Background: The usefulness of cardiac magnetic resonance imaging (MRI) has greatly increased in the last years. Different international registries have been published on its use; however, there is no data available from Argentina. Objective: The aim of this study was to evaluate different indications, protocols, safety and therapeutic consequences of cardiac MRI in Argentina. Methods: A prospective national registry was designed with collection of demographic data, indications for cardiac MRI, associated complications, diagnoses and therapeutic consequences. Results: A total of 34 centers from 10 provinces of Argentina (85% private and 59% with inpatient capacity) participated in the study, including 1131 patients (mean age 54±18 years and 61% males). The main indications for cardiac MRI were hypertrophic cardiomyopathy (13.9%), and ventricular arrhythmia (12.3%). In 99.7% of cases, no study complications were reported. The most frequent results of cardiac MRI were: normal (31.2%), non-ischemic cardiomyopathy (14.7%), ischemic-necrotic cardiomyopathy (11.6%) and hypertrophic cardiomyopathy (8.9%). Clinical suspicion was confirmed in 23.6% of cases and cardiac MRI generated an unsuspected new diagnosis in 48.7% of cases. The main therapeutic consequences were hospital discharge (31.6%) followed by change in medication (28.1%). Conclusions: Cardiac MRI is widely used in Argentina, mainly in private centers with a very low incidence of complications. Cardiomyopathies (hypertrophic and dilated) and ventricular arrhythmia are its main indication, and it provides a new unsuspected diagnosis in almost half of the cases. Further studies are required to assess its clinical and therapeutic impact.

Role of Iterative Reconstruction Algorithm for the Assessment of Myocardial Infarction with Dual Energy Computed Tomography.

RATIONALE AND OBJECTIVES: Low monochromatic energy levels (40 keV) derived from delayed enhancement dual energy cardiac computed tomography (DE-DECT) allow the evaluation of myocardial infarcts (MI) among stable patients, although at the expense of high image noise. We explored whether the application of adaptive statistical iterative reconstruction (ASIR) to 40-keV DE-DECT (unavailable with previous software versions) might improve image quality and detection of MI in stable patients. MATERIALS AND METHODS: We prospectively enrolled patients with a history of previous MI, and performed delayed-enhancement cardiac magnetic resonance (DE-CMR) and DE-DECT within the same week. DE-DECT images were reconstructed with 0% and 60% ASIR. RESULTS: MI was identified in 18 (80%) patients with both DE-CMR and DE-DECT. On a per segment basis, we did not identify significant differences regarding the diagnostic performance of DE-DECT with and without ASIR [area under receiver operating characteristic curve 0.86 vs. 0.83, p = 0.10]. The application of ASIR improved the signal-to-noise ratio of DE-DECT with 0% ASIR compared to DE-DECT with 60% ASIR (6.07 ± 2.1 vs. 11.1 ± 4.5, p < 0.0001). However, qualitative assessment of MI image quality (3.35 ± 1.2, vs. 3.55 ± 1.1, p = 0.10) and diagnostic confidence (4.40 ± 0.9 vs. 4.60 ± 0.8, p = 0.10) were not significantly improved. Using DE-DECT with 60% ASIR, a threshold over 199 HU showed a sensitivity of 67% and a specificity of 92% for the detection of segments with MI. CONCLUSION: In this study, DE-DECT allowed accurate detection of MI among stable patients compared with DE-CMR, and the application of ASIR improved signal-to-noise ratio of DE-DECT, although the diagnostic performance showed only non-significant improvements.

Regional differences of fat depot attenuation using non-contrast, contrast-enhanced, and delayed-enhanced cardiac CT.

BACKGROUND: Regional fat density assessed by computed tomography (CT) has been suggested as a marker of perivascular adipose tissue inflammation. Dual energy CT (DECT) allows improved tissue characterization compared to conventional CT. PURPOSE: To explore whether DECT might aid regional fat density discrimination. MATERIAL AND METHODS: We included patients who had completed a non-enhanced cardiac CT scan, CT coronary angiography (CTCA), and a delayed enhancement CT. Attenuation levels (Hounsfield units [HU]) were assessed at the epicardial, paracardial, visceral, and subcutaneous fat. The number of coronary segments with disease (SIS) was calculated. RESULTS: A total of 36 patients were included in the analysis. Twenty-six (72%) patients had evidence of obstructive disease at CCTA and 25 (69%) patients had evidence of previous myocardial infarction. At non-contrast CT, we did not identify significant attenuation differences between epicardial, paracardial, subcutaneous, and visceral fat depots (-110.8 ± 9 HU, vs. -113.7 ± 9 HU, vs. -114.7 ± 8 HU, vs. -113.8 ± 11 HU, P = 0.36). Significant attenuation differences were detected between fat depots at mid and low energy levels, both at CTCA and delayed-enhancement scans ( P < 0.05 for all). Epicardial fat showed the least negative attenuation, irrespective of the acquisition mode; epicardial fat evaluated at 40 keV was related to the SIS (r = 0.37, P = 0.03). CONCLUSIONS: In this study, regional fat depots amenable to examination during thoracic CT scans have distinctive regional attenuation values. Furthermore, such differences were better displayed using contrast-enhanced monochromatic imaging at low energy levels.

Incremental value of functional assessment over coronary anatomy in an acute myocardial infarction associated with mitral valve replacement.

We present the case of a patient with an aneurysm secondary to a complicated myocardial infarction associated to an occlusion of the obtuse marginal branches during or after valve replacement surgery.

Improved Discrimination of Myocardial Perfusion Defects at Low Energy Levels Using Virtual Monochromatic Imaging.

OBJECTIVES: The aim of this study was to explore the diagnostic performance of dual-energy computed tomography perfusion (DE-CTP) at different energy levels. METHODS: Patients with known or suspected coronary artery disease underwent stress and rest DE-CTP and single-photon emission computed tomography. Images were evaluated using monochromatic data, and perfusion defects were initially identified in a qualitative manner and subsequently confirmed using attenuation levels. RESULTS: Thirty-six patients were included. Sensitivity, specificity, positive predictive value, and negative predictive value of DE-CTP for the identification of perfusion defects were 84.1%, 94.2%, 77.3%, and 96.2%, respectively. Perfusion defects showed significantly lower attenuation than normal segments, with the largest differences among low energy levels (sensitivity of 96% and specificity of 98% using a cutoff value ≤ 153 Hounsfield units at 40 keV), progressively declining at the higher levels (P < 0.001). CONCLUSIONS: Dual-energy CTP at the lowest energy levels allowed improved discrimination of perfusion defects compared with higher energy levels.

Pericardial fat volume is related to atherosclerotic plaque burden rather than to lesion severity.

AIMS: We sought to explore the relationship between pericardial fat volume (PFV) and both coronary atherosclerosis (CA) extent and severity using coronary artery calcium score (CAC), computed tomography coronary angiography (CTCA), and invasive coronary angiography in patients at high to intermediate likelihood of coronary artery disease (CAD). METHODS AND RESULTS: Patients clinically referred to invasive angiography who underwent CTCA and CAC within 1 month before the procedure comprised the study population. PFV, CAC, atherosclerotic burden indexes [segment involvement score (SIS); segment stenosis score; three-vessel plaque; and any left main plaque], and the invasive angiography-derived CAD index were evaluated independently. A total of 75 patients were included in the study. PFV did not differ between patients with or without obstructive (stenosis >70%) CAD defined by invasive angiography (86.4 ± 31.7 vs. 77.1 ± 42.8 cm3, P = 0.34), although patients with obstructive CAD had significantly higher CAC scores [636.0 (IQR 229.5-1101.0) vs. 206.0 (IQR 0.0-675), P < 0.0001] than patients without obstructive CAD. Patients with extensive CA (SIS > 5) had significantly larger PFV (89.9 ± 33.9 vs. 58.7 ± 33.2 cm3, P = 0.003) than patients with non-extensive CA. Significant correlations were found between PFV and CAC (r = 0.49, P < 0.0001), and SIS (r = 0.46, P < 0.0001), whereas very weak correlations were observed between PFV and the CAD index (r = 0.27, P = 0.02), and between PFV and the body mass index (r = 0.33, P = 0.004). CONCLUSION: The main finding of the present study was the identification of PFV as more closely related to atherosclerotic plaque burden rather than to lesion severity in patients referred to invasive coronary angiography.

Espesores parietales regionales en pacientes con y sin miocardiopatías evaluados por resonancia magnética cardíaca / Myocardial regional thickness in patients with and without cardiomyopathy assessed by cardiac magnetic resonance

Resumen Objetivo Explorar las diferencias segmentarias de los espesores parietales (EP) en las miocardiopatías más prevalentes y en individuos sin cardiopatía estructural por resonancia magnética cardíaca. Método Pacientes mayores de 18 años referidos a resonancia magnética cardíaca durante el periodo comprendido entre enero de 2014 y septiembre de 2014, con diagnóstico de miocardiopatía hipertrófica, miocardiopatía dilatada idiopática, miocardiopatía isquémico-necrótica y miocarditis fueron seleccionados retrospectivamente de nuestra base de datos. Resultados Se incluyeron 120 pacientes. El grupo control presentó un EP medio de 5.9 ± 1.1 mm, con un índice de espesor relativo de 2.9 ± 0.8. Se identificaron EP significativamente menores en los segmentos apicales tanto en el grupo control (basal 6.7 ± 1.3 vs. medio 6 ± 1.3 vs. apical 4.6 ± 1 mm, p < 0.0001) como en todas las miocardiopatías evaluadas (miocardiopatía hipertrófica: basal 10.5 ± 2.4 vs. medio 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, p < 0.0001; miocardiopatía dilatada idiopática: basal 7.7 ± 1.7 vs. medio 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, p < 0.0001; miocardiopatía isquémico-necrótica: basal 7.4 ± 1.7 vs. medio 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, p < 0.0001; miocarditis: basal 7.1 ± 1.5 vs. medio 6.4 ± 1.1 vs. apical 5.1 ± 0.8, p < 0.0001). También se evidenciaron diferencias significativas entre hombres y mujeres respecto al EP tanto en el grupo control (6.5 ± 2.1 vs. 5.2 ± 1.7 mm, p < 0.0001), como en la miocardiopatía hipertrófica (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, p < 0.0001) y en la miocarditis (6.6 ± 2 vs. 5.2 ± 1.6 mm, p < 0.0001). Conclusiones En este estudio observacional encontramos un prevalencia relativamente elevada de segmentos comúnmente considerados como adelgazados en individuos sin cardiopatía estructural. Además, observamos una marcada asimetría y gradiente longitudinal en cuanto a EP tanto en controles como en las distintas miocardiopatías evaluadas.

Abstract Objective To explore regional differences in myocardial wall thickness (WT) among the most prevalent cardiomyopathies and in individuals without structural heart disease using cardiac magnetic resonance. Methods Patients older than 18 years referred to cardiac magnetic resonance during the period between January 2014 and September 2014, with a diagnosis of hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and myocarditis were retrospectively selected from our database. Results One hundred twenty patients patients were included. The control group had an average WT of 5.9 ± 1.1 mm, with a WT index of 2.9 ± 0.8. Significantly lower mean WT in the apical segments were identified in both the control group (basal 6.7 ± 1.3 vs. mid 6.0 ± 1.3 vs. apical 4.6 ± 1.0 mm, P < .0001) and in all evaluated cardiomyopathies (hypertrophic cardiomyopathy: basal 10.5 ± 2.4 vs. mid 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, P < .0001; idiopathic dilated cardiomyopathy: basal 7.7 ± 1.7 vs. mid 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, P < .0001; ischemic cardiomyopathy: basal 7.4 ± 1.7 vs. mid 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, P < .0001; myocarditis: basal 7.1 ± 1.5 vs. mid 6.4 ± 1.1 vs. apical 5.1 ± 0.8, P < .0001). Significant gender differences were also evident regarding the mean WT both in the control group (male 6.5 ± 2.1 vs. female 5.2 ± 1.7 mm, P < .0001), as in hypertrophic cardiomyopathy (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, P < .0001) and myocarditis (6.6 ± 2.0 vs. 5.2 ± 1.6 mm, P < .0001). Conclusion We found a relatively high prevalence of segments commonly deemed thinned among patients without structural heart disease. We also observed a marked asymmetry and longitudinal gradient in wall thickness both in controls and in the various cardiomyopathies evaluated.

Virtual Monochromatic Imaging in Patients with Intermediate to High Likelihood of Coronary Artery Disease: Impact of Coronary Calcification.

RATIONALE AND OBJECTIVES: We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification. MATERIALS AND METHODS: Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population. RESULTS: Sixty-seven patients were included. Image quality was significantly lower at 45 keV reconstructions (mean Likert score 45 keV 3.57 ± 0.6, 65 keV 4.07 ± 0.5, and 85 keV 4.09 ± 0.6; P < .0001). Patients with moderate calcification showed a trend toward a significant improvement in the diagnostic performance with 65 keV vs 45 keV reconstructions (45 keV, area under the curve 0.92 [95% confidence interval 0.89-0.95] vs 65 keV, area under the curve 0.96 [95% confidence interval 0.93-0.98], P = .06). The diagnostic performance of DE-CTCA was significantly lower in segments with higher coronary artery calcium scoring compared to segments with none or mild calcification, independent of the energy level applied. CONCLUSIONS: In patients with intermediate to high likelihood of CAD, DE-CTCA had a good diagnostic performance, although significantly lower in segments with severe calcification.

Extension and Spatial Distribution of Atherosclerotic Burden Using Virtual Monochromatic Imaging Derived From Dual-energy Computed Tomography.

INTRODUCTION AND OBJECTIVES: We explored the differences between atherosclerotic burden with invasive coronary angiography and virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography. METHODS: Eighty consecutive patients referred for invasive coronary angiography underwent dual-energy computed tomography coronary angiography and were categorized according to the atherosclerotic burden extent using the modified Duke prognostic coronary artery disease index, coronary artery disease extension score, segment involvement score, and the segment stenosis score. RESULTS: The mean segment involvement score (8.2 ± 3.9 vs 6.0 ± 3.7; P < .0001), modified Duke index (4.33 ± 1.6 vs 4.0 ± 1.7; P = .003), coronary artery disease extension score (4.84 ± 1.8 vs 4.43 ± 2.1; P = .005), and the median segment stenosis score (13.5 [9.0-18.0] vs 9.5 [5.0-15.0]; P < .0001) were significantly higher on dual-energy computed tomography compared with invasive angiography. Dual-energy computed tomography showed a significantly higher number of patients with any left main coronary artery lesion (46 [58%] vs 18 [23%]; P < .0001) and with severe proximal lesions (0.28 ± 0.03 vs 0.26 ± 0.03; P < .0001) than invasive angiography. Levels of coronary artery calcification below and above the median showed a sensitivity, specificity, positive predictive value, and negative predictive value of 100% and 97%; 86% and 50%; 93% and 95%; 100% and 67% for the identification of ≥ 50% stenosis. CONCLUSIONS: Dual-energy computed tomography coronary angiography identified a significantly larger atherosclerotic burden compared with invasive coronary angiography, particularly involving the proximal segments.

[Myocardial regional thickness in patients with and without cardiomyopathy assessed by cardiac magnetic resonance]. / Espesores parietales regionales en pacientes con y sin miocardiopatías evaluados por resonancia magnética cardíaca.

OBJECTIVE: To explore regional differences in myocardial wall thickness (WT) among the most prevalent cardiomyopathies and in individuals without structural heart disease using cardiac magnetic resonance. METHODS: Patients older than 18 years referred to cardiac magnetic resonance during the period between January 2014 and September 2014, with a diagnosis of hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and myocarditis were retrospectively selected from our database. RESULTS: One hundred twenty patients patients were included. The control group had an average WT of 5.9±1.1mm, with a WT index of 2.9±0.8. Significantly lower mean WT in the apical segments were identified in both the control group (basal 6.7±1.3 vs. mid 6.0±1.3 vs. apical 4.6±1.0mm, P<.0001) and in all evaluated cardiomyopathies (hypertrophic cardiomyopathy: basal 10.5±2.4 vs. mid 10.8±2.7 vs. apical 7.3±3.3mm, P<.0001; idiopathic dilated cardiomyopathy: basal 7.7±1.7 vs. mid 7.6±1.3 vs. apical 5.4±1.3mm, P<.0001; ischemic cardiomyopathy: basal 7.4±1.7 vs. mid 7.5±1.9 vs. apical 5.5±1.8mm, P<.0001; myocarditis: basal 7.1±1.5 vs. mid 6.4±1.1 vs. apical 5.1±0.8, P<.0001). Significant gender differences were also evident regarding the mean WT both in the control group (male 6.5±2.1 vs. female 5.2±1.7mm, P<.0001), as in hypertrophic cardiomyopathy (10.5±5.3 vs. 8.5±5.7mm, P<.0001) and myocarditis (6.6±2.0 vs. 5.2±1.6mm, P<.0001). CONCLUSION: We found a relatively high prevalence of segments commonly deemed thinned among patients without structural heart disease. We also observed a marked asymmetry and longitudinal gradient in wall thickness both in controls and in the various cardiomyopathies evaluated.

Dual energy imaging and intracycle motion correction for CT coronary angiography in patients with intermediate to high likelihood of coronary artery disease.

We explored whether intracycle motion correction algorithms (MCAs) might be applicable to dual energy computed tomography coronary angiography in patients with intermediate to high likelihood of coronary artery disease. MCA reconstructions were associated with higher interpretability rates (96.7% vs. 87.9%, P<.001), image quality scores (4.12 ± 0.9 vs. 3.76 ± 1.0; P<.0001), and diagnostic performance [area under the curve of 0.95 (95% confidence interval [CI] 0.92-0.97) vs. 0.89 (95% CI 0.86-0.92); P<.0001] compared to conventional reconstructions. In conclusion, application of intracycle MCA reconstructions to dual energy computed tomography acquisitions was feasible and resulted in significantly higher image quality scores, interpretability, and diagnostic performance.

Myocardial signal density levels and beam-hardening artifact attenuation using dual-energy computed tomography.

The assessment of myocardial perfusion using single-energy (SE) imaging is influenced by beam-hardening artifacts (BHA). We sought to explore the ability of dual-energy (DE) imaging to attenuate the presence of BHA. Myocardial signal density (SD) was evaluated in 2240 myocardial segments (112 for each energy level) and in 320 American Heart Association segments among the SE group. Compared to DE reconstructions at the best energy level, SE acquisitions showed no significant differences overall regarding myocardial SD or signal-to-noise ratio. The segments most commonly affected by BHA showed significantly lower myocardial SD at the lowest energy levels, progressively normalizing at higher energy levels.

Beam hardening artifact reduction using dual energy computed tomography: implications for myocardial perfusion studies.

BACKGROUND: Myocardial computed tomography perfusion (CTP) using conventional single energy (SE) imaging is influenced by the presence of beam hardening artifacts (BHA), occasionally resembling perfusion defects and commonly observed at the left ventricular posterobasal wall (PB). We therefore sought to explore the ability of dual energy (DE) CTP to attenuate the presence of BHA. METHODS: Consecutive patients without history of coronary artery disease who were referred for computed tomography coronary angiography (CTCA) due to atypical chest pain and a normal stress-rest SPECT and had absence or mild coronary atherosclerosis constituted the study population. The study group was acquired using DE and the control group using SE imaging. RESULTS: Demographical characteristics were similar between groups, as well as the heart rate and the effective radiation dose. Myocardial signal density (SD) levels were evaluated in 280 basal segments among the DE group (140 PB segments for each energy level from 40 to 100 keV; and 140 reference segments), and in 40 basal segments (at the same locations) among the SE group. Among the DE group, myocardial SD levels and myocardial SD ratio evaluated at the reference segment were higher at low energy levels, with significantly lower SD levels at increasing energy levels. Myocardial signal-to-noise ratio was not significantly influenced by the energy level applied, although 70 keV was identified as the energy level with the best overall signal-to-noise ratio. Significant differences were identified between the PB segment and the reference segment among the lower energy levels, whereas at ≥70 keV myocardial SD levels were similar. Compared to DE reconstructions at the best energy level (70 keV), SE acquisitions showed no significant differences overall regarding myocardial SD levels among the reference segments. CONCLUSIONS: BHA that influence the assessment of myocardial perfusion can be attenuated using DE at 70 keV or higher.

Effect of intracycle motion correction algorithm on image quality and diagnostic performance of computed tomography coronary angiography in patients with suspected coronary artery disease.

RATIONALE AND OBJECTIVES: We sought to explore the impact of intracycle motion correction algorithms (MCA) in the interpretability and diagnostic accuracy of computed tomography coronary angiography (CTCA) performed in patients suspected of coronary artery disease (CAD) referred to invasive coronary angiography. MATERIALS AND METHODS: Patients with suspected CAD referred to invasive coronary angiography previously underwent CTCA. Patients under rate-control medications were advised to withhold for the previous 24 hours. The primary end point of the study was to evaluate image interpretability and diagnostic performance of MCA compared to conventional reconstructions in patients referred to invasive angiography because of suspected CAD. RESULTS: Thirty-five patients were prospectively included in the study protocol. The mean age was 61.4 ± 9.4 years. Twenty-seven (77%) patients were men. A total of 533 coronary segments were evaluated using conventional and MCA reconstructions. MCA reconstructions were associated to higher interpretability rates (525 of 533, 98.5% vs. 515 of 533, 96.6 %; P < .001) and image quality scores (3.88 ± 0.54 vs. 3.78 ± 0.76; P < .0001) compared to conventional reconstructions. Although only mild, a significant difference was observed regarding the diagnostic performance between reconstruction modes, with an area under the curve of 0.90 (0.87-0.92) versus 0.89 (0.86-0.92), respectively, for MCA and conventional reconstructions (P = .0447). CONCLUSIONS: In this pilot investigation, MCA reconstructions performed in patients with suspected CAD were associated to higher interpretability rates and image quality scores compared to conventional reconstructions, although only mild differences were observed regarding the diagnostic performance between reconstruction modes.