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Cardiovascular Magnetic Resonance
UChicago Medicine research discovers new insights into pacemaker use in heart failure patients. Growing up with congenital heart disease. Myocardial ischemia as the principal manifestation of CAD can be detected by first-pass perfusion test. Rest myocardial blood flow will keep constant unless the significant stenosis exists, thus, physiological or pharmacological stress is necessary for the detection of myocardial ischemia.
LGE images of myocardial scar using current segmented inversion recovery gradient echo pulse sequences can be obtained in one breath hold.
Gadolinium-based contrast agents are extra-cellular, thus, they can diffuse freely in to the interstitial space. In acute myocardial infarction, the cell barriers were destroyed, and distribution volume is increased. In chronic infarction myocardial cells are replaced with a fibrotic matrix which also cause the distribution volume increasing. LGE always extends from the endocardium outwards due to the process of myocyte necrosis spreading from sub-endocardium to the epicardial borders.
Figure 3 is an inversion recovery delayed-enhancement image acquisition program with phase-sensitive detection was used to acquire LGE images from an inferior non-transmural myocardial infarcted patient yellow arrow. LGE can not only determine the presence, location and extent of infarcted myocardium, but also can identify the stunned myocardium prior to revascularization [ 7 ]. An inversion recovery delayed-enhancement image acquisition program with phase-sensitive detection was used to acquire LGE images from an inferior wall non-transmural myocardial infarcted patient yellow arrow.
The inversion time a timing option was adjusted to null the normal myocardium. Thus, normal myocardium appears uniformly dark in these ventricular sagittal a and short axis b and c views. Most of the non-ischemic heart disease is characterized by an alteration of ventricular and myocardial geometry or function. For the measurement of morphology and function, a stack of short-axis slices covering the entire left ventricle from the mitral plane to the apex can be used [ 16 ].
LGE further enhances the tissue characterization abilities of CMRI which shortens T1 relaxation time and brightens the area where gadolinium chelates accumulates. Myocardial tissue characterization of non-ischemic heart disease can be quantitatively evaluated through T1 mapping and T2 mapping. HCM is a genetic disease characterized by myocardial disarray, symmetrical or asymmetrical myocardial hypertrophy, most frequently occur in the septum with the loss of diastolic function or and possible dynamic systolic obstruction of the LV outflow tract [ 17 ].
Cine imaging can accurately assess the wall thickness, and it can be used to detect anterior motion of mitral valve leaflet in systole. Myocardial tagging imaging shows a decreasing of circumferential shortening and fractional thickening in region of thickened myocardium.
Cardiac magnetic resonance imaging in clinical practice
LGE imaging can determine the areas of fibrosis based on increasing collagen content, which have a positive correlation with risk of lethal arrhythmias [ 18 ]. Hypertrophic cardiomyopathy. Black blood image showed symmetric myocardial hypertrophy yellow asterisks.
Left ventricular outflow tract obstruction and a turbulent flow within the aorta white arrow, B. LGE image demonstrated heterogeneous enhancement of the hypertrophied myocardium yellow arrowheads. A diffuse myocardial fibrosis is usually detected in histopathological studies. LGE can accurately demonstrate the enhancement of ischemic DCM begins from sub-endocardial layers, while, focal fibrosis in non-ischemic DCM spares the sub-endocardial layers and shows either mid-wall patchy enhancement pattern or lack of enhancement. Focal septal fibrosis in DCM, the so-called mid-wall sign, has been linked to ventricular arrhythmia which is a main cause of sudden death.
Primary RCM is characterized by impaired diastolic volume of both ventricles without dysfunction of systolic, a biatrial dilation and normal or small LV size can also be detected. CMR can assess RCM accurately based on its high contrast resolution and the ability of comprehensive evaluation of cardiomyopathies. Phase contrast imaging allows quantitative assessment of flow across the atrioventricular valves.
In early stage, reduced diastolic function causes the decrease of early ventricular relaxation velocities and the increase of late atrial contraction velocities. In later period, a restrictive filling will appear with rapid and tall early filling waves and much reduced atrial waves. In RCM patients, contours of ventricular cavities are maintained with atrial enlargement.
CMR is the best imaging technique to confirm suspected myocarditis and detect focal inflammation and scarring. The diagnostic criteria of CMR for myocarditis was proposed for the first time in the year of [ 19 ], which depicted that myocarditis would have the following characteristics: 1. The hyper-enhancement lesions is less bright than myocardial infarction and most frequently arise in the inferolateral wall.
Furthermore, T2-weighted CMR T1 mapping can detect the edema which appears local or diffusing hyper-enhancement. A T2 Stir image from a myocarditis patient.
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High T2 signal indicating edema is seen in subepicardial area of septum, lateral wall, etc. LGE shows enhancements occur in the same area blue arrowheads. CMRI has revolutionized cardiac imaging. Recent advances in cardiac imaging include T1 mapping, T2 mapping, and MR-guided therapy.
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With the promise of higher spatial—temporal resolution and 3D coverage at higher field strength, in the near future, CMRI will become an routine tool in the diagnosis of cardiac diseases. Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution 3. Help us write another book on this subject and reach those readers. Login to your personal dashboard for more detailed statistics on your publications. Call us on Patients About your care Make, cancel or change an appointment Staying in hospital Your outpatient appointment Give your feedback.
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