Applications Of Cardiovascular Magnetic Resonance Research Articles

Cardiovascular magnetic resonance imaging of myocardial inflammation

Cardiovascular magnetic resonance (CMR) imaging can precisely quantify cardiac size and function, but moreover depict tissue changes that are associated with various forms of myocardial inflammation. Thereby, CMR can often detect myocardial inflammation before contractility is obviously impaired. Various CMR techniques to assess aspects of inflammation including T2-weighted imaging, and early- and late-contrast enhanced T1-weighted imaging, are reviewed regarding technical challenges and clinical usefulness. In this article we discuss the available evidence regarding clinical application of CMR in different forms of myocardial inflammation.

Cardiac magnetic resonance imaging: A teaching atlas with emphasizing current clinical indications

Cardiovascular magnetic resonance (CMR) is an amazing technology that continues to provide new innovative approaches for evaluating the heart and blood vessels. It can assess cardiac morphology, function, perfusion, viability, coronary and peripheral arteries, and metabolism and tissue characterization. The basic pulse sequences of CMR include; Spin Echo, Gradient echo, and Steady stet free precision. Current clinical indications of CMR are multiple and continuously evolving. CMR often works in complementary fashions to other cardiac imaging techniques or to resolve residual diagnostic dilemma. The purpose of this illustrative review is to review current clinical applications of CMR and to provide physicians and technologists with simple, and regular CMR cases form daily practice. Each case discusses briefly the related clinical history, followed by CMR imaging findings, and simple discussion to highlight the role of CMR in a particular cardiovascular disorder.

Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance.

Over the past years, cardiovascular magnetic resonance (CMR) has proven its efficacy in large clinical trials, and consequently, the assessment of function, viability, and ischaemia by CMR is now an integrated part of the diagnostic armamentarium in cardiology. By combining these CMR applications, coronary artery disease (CAD) can be detected in its early stages and this allows for interventions with the goal to reduce complications of CAD such as infarcts and subsequently chronic heart failure (CHF). As the CMR examinations are robust and reproducible and do not expose patients to radiation, they are ideally suited for repetitive studies without harm to the patients. Since CAD is a chronic disease, the option to monitor CAD regularly by CMR over many decades is highly valuable. Cardiovascular magnetic resonance also progressed recently in the setting of acute coronary syndromes. In this situation, CMR allows for important differential diagnoses. Cardiovascular magnetic resonance also delineates precisely the different tissue components in acute myocardial infarction such as necrosis, microvascular obstruction (MVO), haemorrhage, and oedema, i.e. area at risk. With these features, CMR might also become the preferred tool to investigate novel treatment strategies in clinical research. Finally, in CHF patients, the versatility of CMR to assess function, flow, perfusion, and viability and to characterize tissue is helpful to narrow the differential diagnosis and to monitor treatment.

CMR for Assessment of Diastolic Function.

Prevalence of heart failure with preserved left ventricular ejection fraction amounts to 50% of all cases with heart failure. Diagnosis assessment requires evidence of left ventricular diastolic dysfunction. Currently, echocardiography is the method of choice for diastolic function testing in clinical practice. Various applications are in use and recommended criteria are followed for classifying the severity of dysfunction. Cardiovascular magnetic resonance (CMR) offers a variety of alternative applications for evaluation of diastolic function, some superior to echocardiography in accuracy and reproducibility, some being complementary. In this article, the role of the available CMR applications for diastolic function testing in clinical practice and research is reviewed and compared to echocardiography.

The role of cardiovascular magnetic resonance in pediatric congenital heart disease.

Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.

The Use of Cardiovascular Magnetic Resonance in Acute Myocardial Infarction

Acute myocardial infarction (MI) results in reversible and irreversible injury to the myocardium, including stunning, edema, myocyte necrosis, and microvascular obstruction. Because of its unique tissue characterization capabilities, cardiovascular magnetic resonance provides a reliable means of visualizing and quantifying the extent of these injuries. Such characterization is readily achieved through a comprehensive examination including function, first-pass perfusion, T2 (edema), and late enhancement imaging sequences. This helps to predict the prognosis, assess the success of reperfusion, detect acute phase complications, localize the area of the acute event, and confirm the diagnosis in clinical scenarios with clinical presentations similar to that of acute MI. Finally, one emerging application is the role cardiovascular magnetic resonance (CMR) may play in detecting some infarcts very early on in their evolution. This article covers the established and emerging clinical applications of CMR in the settings of reperfused and nonreperfused infarcts and in acute myocardial ischemia, the step immediately preceding actual irreversible injury.

Clinical Application of Cardiac CMR

Obesity is a known risk factor for developing cardiovascular disease, including heart failure. However, the impact of obesity on patients with heart failure is unclear. Weight reduction is a recommended method of prevention of cardiovascular disease. However, the phenomenon of the "obesity paradox" (or "reverse epidemiology") revealed that overweight and mild to moderate obesity are associated with better outcomes in patients with heart failure compared with patients at normal or ideal weight. Even more, increases of weight in cachectic heart failure patients might improve survival, although patients with heart failure who are overweight or mildly to moderately obese have better outcomes than patients with heart failure who are at ideal or normal weight. In heart failure patients, weight reduction through diet regulation, moderate exercise, and bariatric surgery can improve quality of life and New York Heart Association functional class, but it is yet unclear if these measures will improve survival.

Cardiovascular magnetic resonance imaging for valvular heart disease

Valvular heart disease (VHD) is a clinically important diagnosis, with significant associated morbidity and mortality. Multiple imaging modalities exist to characterize valvular and associated cardiac anatomy. Cardiovascular magnetic resonance (CMR) has emerged as a comprehensive noninvasive imaging modality for VHD. With use of well-established, standardized imaging sequences, CMR can accurately and precisely diagnose valvular structural abnormalities, assess severity of regurgitant and stenotic lesions, and potentially define patient prognosis. This article reviews the clinical applications of CMR in assessment of VHD.

Expanding Role of Cardiovascular Magnetic Resonance in Left and Right Ventricular Diastolic Function

This article focuses on the role of cardiovascular magnetic resonance (CMR) in understanding the physiology of diastolic function and on the future applications of CMR as they relate to diastolic function evaluation. CMR has a demonstrated potential to define diastolic function and quantify its properties, in terms of active and passive stages, and its relaxation and compliance characteristics. CMR is also useful for assessing inflow and myocardial velocities, and untwisting properties of the chamber and myocardium, thus providing insights not fully available in other invasive and noninvasive strategies. CMR, which offers the necessary capabilities to evaluate the complex structure of the right ventricle, can serve in the future as the standard for evaluating diastolic function as it currently does for systolic function.

Use of Cardiovascular Magnetic Resonance Imaging in Acute Coronary Syndromes

The clinical role of cardiovascular magnetic resonance (CMR) continues to expand,1 supported by ongoing technological advances that have shortened acquisition times while maintaining and often improving image quality. New applications of CMR in cardiovascular imaging continue to emerge, and results from larger clinical trials are beginning to define the role of CMR in a range of clinical scenarios. Currently accepted indications for CMR include the assessment of congenital heart disease, the great vessels, acquired myocardial and pericardial disease, and chronic coronary artery disease (CAD).1 The role of CMR in the assessment of acute coronary syndromes (ACS) is less well established. However, evidence is accumulating that CMR provides often unique information in chest pain syndromes that can aid in the detection and differential diagnosis of ACS, guide clinical decision making, and improve risk stratification after an event. After reviewing the relevant CMR methodology, the present article puts forward the current evidence for CMR in ACS and gives an outlook of future developments. The following CMR methods are most commonly used to assess ACS (Figure 1) and can be incorporated into a clinical protocol that can be performed within an hour. Figure 1. A, CMR methods for assessment of ACS. Short-axis views (of different patients) illustrate the different imaging techniques used (rows 1 and 2), their morphological correlates (row 3), and main clinical application (row 4). B, These methods can be integrated into a CMR protocol in the sequence indicated to provide a comprehensive assessment of ACS patients. Such a study can be performed in less than 1 hour. Gd indicates gadolinium. ### Cine Imaging The assessment of global and regional left ventricular (LV) and right ventricular (RV) function by CMR is typically based on a cine data set aligned in the true LV short axis that covers the heart in 10 to …

Signal intensity enhances diagnostic capacity in myocardial infarction

Over the past years cardiovascular magnetic resonance (CMR) imaging has become one of the most prominent noninvasive imaging modalities in cardiovascular medicine [1–5]. Using CMR imaging, a wide variety of diseases can be detected varying from coronary artery disease, myocardial viability, vein graft disease to congenital heart disease [6–18]. An interesting application of CMR is the detection and quantification of infarcted myocardium in humans and experimental animals by a technique called delayed-enhancement CMR [19–25]. With this technique a gadolinium CMR contrast agent is injected intravenously followed by a long interval in which the perfused area has lost the contrast, whereas the infarcted area has slowly gained some contrast and releases that contrast with a long delay. The infarcted area is ‘‘enhanced’’ by this delay and this in vivo determined infarct size has been found to correlate well with postmortem determined infarct size [26– 28]. Particularly in non-transmural infarction the area of late gadolinium enhancement correlated only weakly with the infarct size determined by perfusion scintigraphy [29]. The occurrence of microvascular obstruction causes dark zones in the area of late gadolinium enhancement as appearance of gadolinium is obstructed [30, 31]. Over time, the area of delayed gadolinium enhancement becomes progressively smaller due to scar formation and hypertrophy of surviving myocardium. These late gadolinium enhancement techniques use T1-weighted images and are used regularly in clinical cardiology and experimental research. In this issue of the International Journal of Cardiovascular Imaging, Choi et al. [32] investigated to which extent useful information is present in T2weighted images of porcine hearts with reperfused myocardial infarction. For over 25 years it is known that in the acutely infarcted heart the signal intensity in T2-weighted images correlates well with myocardial edema [33, 34]. This ‘‘edema imaging’’ on T2weighted images was shown to be dependent of infarct age: edema-associated hyper-intense zones in T2weighted images resolved over time and the area of T2 abnormality delineated the area at risk rather than the infarcted area [35]. In the present study [32], the left anterior descending artery (LAD) was occluded for 90 or 180 min followed by reperfusion for 90 min. In total 15 pigs were studied of which 9 pigs underwent 90 min of LAD occlusion followed by 90 min of reperfusion, whereas the other 6 pigs underwent 180 min of LAD occlusion followed by 90 min of reperfusion. The Editorial comment at the article titled ‘‘Investigation of T2weighted signal intensity of infarcted myocardium and its correlation with delayed enhancement magnetic resonance imaging in a porcine model with reperfused acute myocardial infarction’’ by Choi et al. doi:10.1007/s10554-009-9425-6.

Use of integrated biomarkers in inflammatory disease of the heart: new insights applying cardiovascular magnetic resonance potential as a biomarker

Non-invasive myocardial tissue characterization of inflammatory heart disease is a challenging task. Cardiovascular magnetic resonance (CMR) has recently emerged as a powerful tool to fill this gap. In this article, the role of CMR is reviewed, particularly emphasizing the use of a comprehensive CMR approach to visualize several reversible and irreversible myocardial tissue changes in this setting. Finally, the authors' vision regarding the potential, challenges and emerging new applications of CMR in non-ischemic and inflammatory cardiomyopathies is provided.

Current Status of 3-T Cardiovascular Magnetic Resonance Imaging

Continued advances in radiofrequency hardware and tailored software have, in recent times, greatly increased the power and performance of magnetic resonance imaging for noninvasive evaluation of cardiovascular diseases. Magnetic resonance imaging can uniquely be manipulated to trade temporal resolution and spatial resolution against each other, depending on whether detailed structural or functional information is required. However, to date, a number of cardiovascular magnetic resonance applications have been somewhat limited due to signal-to-noise ratio constraints, reflecting the narrow imaging window imposed by physiological cardiac motion. By increasing the operating field strength from 1.5 to 3 T, it is possible (in principle) to double the signal-to-noise ratio, which in turn may be "traded" for improvements in spatial resolution, coverage, or imaging speed. In this context, the development of parallel imaging has set the stage for impressive performance improvements in contrast-enhanced magnetic resonance angiography at 3 T. Indeed, one could argue that without parallel acquisition, the bang for the buck in going from 1.5 to 3 T would be limited. In this paper, we discuss the current status of 3-T magnetic resonance imaging for cardiovascular imaging, considering the relative gains and limitations relative to 1.5 T.

Advances in clinical applications of cardiovascular magnetic resonance imaging

Cardiovascular magnetic resonance (CMR) is an evolving technology with growing indications within the clinical cardiology setting. This review article summarises the current clinical applications of CMR. The focus is on...

Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art.

In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

Use of cardiovascular magnetic resonance for diagnosis and management in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder characterized by unexplained myocardial hypertrophy. The condition is associated with sudden cardiac death and is therefore often diagnosed postmortem, especially in the young and in competitive athletes. For this reason, intense research focuses on developing strategies to minimize this tragic consequence. Cardiovascular magnetic resonance (CMR) is a novel imaging modality that provides high-resolution images in an infinite number of planes with additional sequences that allows for tissue characterization and quantification of flow. The most exciting development is the application of late gadolinium-enhanced (LGE) imaging, which allows for in vivo detection of myocardial fibrosis. This review summarizes the current applications of CMR in HCM and also speculates on future applications, particularly the potential for risk stratification using LGE-CMR.

MRI in Ischemic heart disease: From coronaries to myocardium

With an escalating health burden from coronary artery disease (CAD), both as a public health and fiscal issue, evaluation of patients with (CAD) remains an important challenge. With advances in therapy our management options have increased, coinciding with a shift away from treatment alone, to disease prevention and accurate risk stratification. Imaging techniques play an important role in guiding management. Recent advances in cardiovascular magnetic resonance (CMR) enable a detailed non-invasive assessment of patients with a combination of anatomical and functional data to assess the impact of CAD in individual patients. The range of sequences means that myocardial perfusion, viability, coronary angiography and plaque characterization are available in a single study. Outcome data have helped with disease prognostication. In this review, we discuss current and future applications of CMR and consider which patients would benefit from a scan.

Myocardial perfusion imaging by cardiac magnetic resonance

Cardiovascular magnetic resonance (CMR) has been shown to provide high quality data on cardiac and valvular function, perfusion, viability, blood flow, and potentially, on cardiac metabolism as well. Several of these CMR applications (eg, function and viability assessment) matured during the past years and are now established components of a cardiac workup. Perfusion-CMR is close to this status and is already a major contributor to cardiac examinations in a growing number of expert centers. Large multicenter perfusion-CMR trials comparing the diagnostic performance of CMR with other techniques were recently reported yielding areas under the receiver-operator-characteristics curve as a high as 0.85 for coronary artery disease detection (MR-IMPACT). Anticipating a growing role for perfusion-CMR in cardiology in the near future, this article discusses the principles of perfusion-CMR and its integration into the workup of patient with coronary artery disease (CAD). In addition to a functional study, this integration is mainly composed of a perfusion-CMR part, followed by a viability assessment by late enhancement CMR techniques. The principal characteristics of these CMR techniques are compared with those of single photon emission computed tomography (SPECT) and positron emission tomography (PET). After introduction into principles and techniques of perfusion-CMR, some open questions in perfusion-CMR and challenges for the future are addressed. Finally, newer CMR applications are shortly mentioned utilizing hyperpolarized carbon-13 compounds in experimental models for quantification of myocardial perfusion and for real-time assessment of metabolic pathways in postischemic myocardium.

Magnetic Resonance Imaging Evaluation of Congenital Heart Disease: Conotruncal Anomalies

Conotruncal anomalies comprise a diverse group of congenital heart defects involving the outflow tracts of the heart and the great vessels, including tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, interrupted aortic arch, and other anomalies. Cardiovascular magnetic resonance (CMR) imaging plays an increasingly important role in the evaluation of patients with these lesions. Advances in CMR allow comprehensive assessment of cardiovascular anatomy, ventricular function, flow, and myocardial perfusion and viability. This article reviews the clinical aspects and the application of CMR before and after surgery in key conotruncal anomalies.

Clinical Applications of Cardiovascular Magnetic Resonance

The clinical role of magnetic resonance in diseases of the heart and great vessels is rapidly evolving. Cardiovascular magnetic resonance (CMR) has become an established non-invasive imaging modality for the assessment of various cardiac disorders, such as congenital heart disease, cardiac masses, cardiomyopathies, aortic and pericardial diseases. Moreover, due to its accuracy and reproducibility, CMR is currently considered the gold standard for quantification of ventricular volumes, function, and mass. Thus, this technique is ideally suited to assess the efficacy of therapeutic interventions on ventricular hypertrophy and remodelling, which may allow a reduction in sample size to show clinically relevant effects. Comprehensive functional assessment is possible by CMR due to its capability to measure flow velocity and flow volume, which is a basic requirement to quantify lesion severity in valvular heart disease. Within the past years, major technical advances have considerably improved acquisition speed and image quality making CMR a useful tool for the evaluation of patients with ischaemic heart disease. Although the clinical robustness of coronary magnetic resonance angiography still needs improvement, CMR currently provides valuable information to detect reversible ischemia, myocardial infarction, and residual viability. In this review we will present in detail the well-established indications of CMR accompanied by an outlook on new applications that are likely to enter the clinical arena in the near future.