非增强冠状动脉MR血管成像的技术进展与临床应用

Non-Contrast-Enhanced Coronary Magnetic Resonance Angiography: Technical Advances and Clinical Applications

摘要: 冠状动脉疾病的准确评估对于缺血性心脏病的筛查、诊断和随访至关重要。冠状动脉CT血管成像和有创冠状动脉造影虽已广泛应用，但分别存在电离辐射、碘对比剂相关风险及有创性等局限。非增强冠状动脉磁共振血管成像(non-contrast coronary magnetic resonance angiography, NC-CMRA)无需电离辐射和对比剂，且具有良好的软组织对比度高、受钙化影响较小、可重复检查以及便于联合心脏磁共振多参数成像等优点，尤其适用于儿童、川崎病患者、肾功能不全者及碘对比剂过敏者。近年来，3.0 T高场强系统、自由呼吸全心成像、Dixon水脂分离、压缩感知、并行成像、快速场回波–平面回波成像及运动校正等技术不断发展，显著提升了成像效率和图像质量。现有研究表明，NC-CMRA对显著冠状动脉狭窄具有较高敏感度和阴性预测价值，在冠状动脉起源异常、冠状动脉瘤及川崎病随访中亦具有独特优势。然而，其空间分辨率、检查成功率和诊断稳定性仍受心率、呼吸模式、磁场不均匀及操作者经验等因素影响，尚不能完全替代冠状动脉CT血管成像或有创冠状动脉造影。基于2021~2023年相关研究、专家共识及基础文献，本文综述NC-CMRA的成像原理、技术进展、临床应用、局限和发展方向，以期为其规范应用与进一步研究提供参考。

Abstract: Accurate assessment of coronary artery disease is crucial for screening, diagnosis, and follow-up of ischemic heart disease. Although coronary CT angiography and invasive coronary angiography are widely used, both have inherent limitations, including ionizing radiation, iodinated contrast exposure, and invasiveness. Non-contrast coronary magnetic resonance angiography (NC-CMRA) avoids ionizing radiation and contrast agents and offers high soft-tissue contrast, reduced susceptibility to calcification, repeatability, and compatibility with multiparametric cardiac MR, making it particularly suitable for children, patients with Kawasaki disease, renal insufficiency, or contrast allergy. In recent years, advances in 3.0 T systems, free-breathing whole-heart imaging, Dixon water-fat separation, compressed sensing, parallel imaging, turbo field echo-echo planar imaging, and motion correction have markedly improved imaging efficiency and image quality. Current evidence suggests that NC-CMRA has high sensitivity and negative predictive value for significant coronary stenosis and offers unique advantages in the follow-up of anomalous coronary origin, coronary aneurysm, and Kawasaki disease. Nevertheless, its spatial resolution, examination success rate, and diagnostic robustness remain affected by heart rate, rhythm, breathing pattern, magnetic field inhomogeneity, and operator experience, and it cannot yet fully replace coronary CT angiography or invasive angiography. Based on studies published from 2021 to 2023, expert consensus statements, and foundational literature, this review summarizes the imaging principles, technical advances, clinical applications, limitations, and future directions of NC-CMRA to support standardized use and further research.