Cardiac magnetic resonance imaging – clinical applications and limitations

    Authors

    Keywords

    magnetic resonance, cardiomyopathies, congenital heart diseases, ischemic heart disease

    DOI

    https://doi.org/10.15836/ccar2016.478

    Full Text

    Cardiac magnetic resonance imaging (MRI) is frequently used for evaluation of cardiac diseases. It enables depiction of cardiac morphology and function, with precise measurement of biventricular volumes, ejection fraction, myocardial mass, as well as quantitation of valvular disease. The main indications for cardiac MRI are myocardial diseases, ischemic heart disease, congenital heart diseases, cardiac masses and pericardial diseases. (1-3) The MRI scan is safe for patients with prosthetic valves, sternal wires and coronary stents. Cardiac MRI examination is also possible in patients with an MR-compatible pacemaker or defibrillator designed and tested for full-body MRI scan, but detailed analysis of the heart is often precluded by artifacts. During MRI scan gadolinium-based contrast agent is usually administered intravenously, but should be avoided in patients with estimated glomerular filtration rate < 30 ml/min and in dialysis patients because of increased risk for nephrogenic systemic fibrosis. Late gadolinium enhancement (LGE) is present in scar regions. Based on LGE pattern etiology of cardiomyopathy can be determined, ischemic dilated cardiomyopathy differentiated from non-ischemic, and myocardial affection with systemic diseases (amiloidosis, sarcoidosis...) can be detected. The most common emergent indication for cardiac MRI is myocarditis that is morphologically characterized by myocardial edema, and subepicardial early or late enhancement. On the contrary, infarct scar presents with subendocardial to transmural LGE, whereas reversible ischemic changes can be depicted using stress perfusion imaging with administration of vasodilator, usually adenosine. In follow-up of patients with congenital heart diseases using MRI it is possible to determine right and left ventricular volumes and function, myocardial mass, grade of valvular disease and significance of shunt by measurement of flow through the pulmonary and systemic circulation.

    Literature

    1. Quarta G, Sado DM, Moon JC. Cardiomyopathies: focus on cardiovascular magnetic resonance. Br J Radiol. 2011;84(Spec No 3):S296–305. https://doi.org/10.1259/bjr/67212179
    2. von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Cardiovascular magnetic resonance imaging in ischemic heart disease. J Magn Reson Imaging. 2012;36(1):20–38. https://doi.org/10.1002/jmri.23580
    3. van der Hulst AE, Roest AA, Westenberg JJ, Kroft LJ, de Roos A. Cardiac MRI in postoperative congenital heart disease patients. J Magn Reson Imaging. 2012;36(3):511–28. https://doi.org/10.1002/jmri.23604
    Cardiologia Croatica
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    Cardiac magnetic resonance imaging – clinical applications and limitations

    Extended Abstract
    Issue10-11
    Published
    Pages478
    PDF via DOIhttps://doi.org/10.15836/ccar2016.478
    magnetic resonance
    cardiomyopathies
    congenital heart diseases
    ischemic heart disease

    Authors

    Maja Hrabak Paar*ORCIDUniversity of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: majahrabak@gmail.com

    Full Text

    Cardiac magnetic resonance imaging (MRI) is frequently used for evaluation of cardiac diseases. It enables depiction of cardiac morphology and function, with precise measurement of biventricular volumes, ejection fraction, myocardial mass, as well as quantitation of valvular disease. The main indications for cardiac MRI are myocardial diseases, ischemic heart disease, congenital heart diseases, cardiac masses and pericardial diseases. (1–3) The MRI scan is safe for patients with prosthetic valves, sternal wires and coronary stents. Cardiac MRI examination is also possible in patients with an MR-compatible pacemaker or defibrillator designed and tested for full-body MRI scan, but detailed analysis of the heart is often precluded by artifacts. During MRI scan gadolinium-based contrast agent is usually administered intravenously, but should be avoided in patients with estimated glomerular filtration rate < 30 ml/min and in dialysis patients because of increased risk for nephrogenic systemic fibrosis. Late gadolinium enhancement (LGE) is present in scar regions. Based on LGE pattern etiology of cardiomyopathy can be determined, ischemic dilated cardiomyopathy differentiated from non-ischemic, and myocardial affection with systemic diseases (amiloidosis, sarcoidosis...) can be detected. The most common emergent indication for cardiac MRI is myocarditis that is morphologically characterized by myocardial edema, and subepicardial early or late enhancement. On the contrary, infarct scar presents with subendocardial to transmural LGE, whereas reversible ischemic changes can be depicted using stress perfusion imaging with administration of vasodilator, usually adenosine. In follow-up of patients with congenital heart diseases using MRI it is possible to determine right and left ventricular volumes and function, myocardial mass, grade of valvular disease and significance of shunt by measurement of flow through the pulmonary and systemic circulation.

    Literature

    1. 1.
      Quarta G, Sado DM, Moon JC. Cardiomyopathies: focus on cardiovascular magnetic resonance. Br J Radiol. 2011;84(Spec No 3):S296–305.DOI
    2. 2.
      von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Cardiovascular magnetic resonance imaging in ischemic heart disease. J Magn Reson Imaging. 2012;36(1):20–38.DOI
    3. 3.
      van der Hulst AE, Roest AA, Westenberg JJ, Kroft LJ, de Roos A. Cardiac MRI in postoperative congenital heart disease patients. J Magn Reson Imaging. 2012;36(3):511–28.DOI