Cardiovascular MRI
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ACR Practice
Guidelines Aorta ARVD Basic Information Cardiomyopathy Congenital
Heart Disease Contrast Enhancement
Cardiac Coronary Arteries Heart Failure Ischemia
Infarction Lower Extremity MRA Masses MR Angiography MR Venography Myocarditis Nomenclature Noncompaction Pericardium Phase Contrast
Plaque Evaluation Shunts Thoracic Outlet Syndrome Valves Venography
ACR PRACTICE GUIDELINES
· ACR practice guideline for the performance and interpretation of cardiac MRI
· Clinical evaluation of aortic coarctation with 4D flow MR imaging
· Collateral flow in coarctation of the aorta with magnetic resonance velocity mapping: Correlation to morphological imaging of collateral vessels http://www3.interscience.wiley.com/cgi-bin/fulltext/89013485/HTMLSTART
· Velocity-encoded Cine MR Imaging in Aortic Coarctation: Functional Assessment of Hemodynamic Events
à
The percentage increase in flow from the
proximal to the distal aorta bears a direct linear relationship to the
percentage of aortic stenosis measured on MR images.
· MR Angiography for Patient Surveillance After Endovascular Repair of Abdominal Aortic Aneurysms
· MR Angiography in the Evaluation of Atherosclerotic Peripheral Vascular Disease
· MR Imaging of Aortic and Peripheral Vascular Disease http://radiographics.rsnajnls.org/cgi/content/full/23/suppl_1/S59
· Natural History and CT Appearances of Aortic Intramural Hematoma
à Axial MR images, like axial CT images, depict aortic dilatation and a crescentic intramural fluid collection. On gradient-echo (white-blood) images, an acute intramural hematoma (aged <7 days) shows T2 signal hyperintensity, whereas a subacute or chronic intramural hematoma (aged ≥7 days) has intermediate T2 signal intensity. On T1-weighted spin-echo (black-blood) images, an acute intramural hematoma appears isointense because of the presence of oxyhemoglobin; however, as the hematoma evolves, it becomes T1 hyperintense because of the presence of methemoglobin. Intramural hematomas should be monitored with follow-up imaging for these signal intensity changes; an absence of the expected changes may be indicative of ongoing hemorrhage, with a worse prognosis. On dynamic phase-contrast images, an absence of flow within the aortic wall supports the diagnosis of intramural hematoma rather than that of communicating aortic dissection.
· CT and MRI in Diseases of the Aorta http://www.ajronline.org/cgi/content/full/193/4/928
· Takayasu arteritis: protean radiologic manifestations and diagnosis. http://radiographics.rsna.org/content/17/3/579
· Unenhanced MR Angiography of the Thoracic Aorta: Initial Clinical Evaluation
· Arrhythmogenic Right Ventricular Dysplasia
à The most common location for this tissue transformation is between the anterior infundibulum, right ventricular apex, and inferior or diaphragmatic aspect of the right ventricle, the so-called “triangle of dysplasia”
· Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Need for an International Registry (Circulation 2000)
· Diagnosis of Arrhythmogenic Right Ventricular Dysplasia: A Review (Radiographics 2002)
· MR features of arrhythmogenic right ventricular dysplasia
· Myocardial Fat at Cardiac Imaging: How Can We Differentiate Pathologic from Physiologic Fatty Infiltration? (Radiographics 2010)
· Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia
· Cardiac MR Imaging: A Guide for the Beginner http://radiographics.rsnajnls.org/cgi/content/full/19/4/1009
· Cardiac MR imaging: state of the technology. Radiology. 2006 Nov;241(2):338-54. Review.
· EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase.. J Am Coll Cardiol. 2009 Oct 6;54(15):1457-66.
· Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols http://scmr.org/assets/files/1532-429X-10-35.pdf
· The Role of Cardiovascular MRI in Heart Failure and the Cardiomyopathies; Magn Reson Imaging Clin N Am 15 (2007) 541–564
· Cardiac MR Imaging of Nonischemic Cardiomyopathies: Imaging Protocols and Spectra of Appearances Radiology February 2012
·
Contemporary
Definitions and Classification of the Cardiomyopathies Circulation 2006
· Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Proposed Modification of the Task Force Criteria Circulation 2010
· MRI of Cardiomyopathy AJR 2008
· Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies Circulation 1996
· Hypertrophic Cardiomyopathy: Assessment with MR Imaging and Multidetector CT (Radiographics 2010)
· Late Myocardial Enhancement in Hypertrophic Cardiomyopathy with Contrast-Enhanced MR Imaging (AJR 2003)
· Cardiac Sarcoidosis: Spectrum of MRI Features (AJR 2005)
CONTRAST ENHANCEMENT
(CARDIAC)
· Contrast-enhanced MR Imaging of the Heart: Overview of the Literature
· Delayed Enhancement MR Imaging: Utility in Myocardial Assessment (Radiographics 2006)
· Application of MRI in Assessment & Follow-up of Congenital Heart Disease in Adults Radiographics July 2010
· Segmental Approach to Imaging of Congenital Heart Disease
· Coronary artery anomalies on CT angiography Applied Radiology June 2011
· Coronary MR Imaging: Effect of Timing and Dose of Isosorbide Dinitrate Administration
· Normal Coronary Anatomy and Anatomic Variations Applied Radiology January 2007
· The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure JACC 2009
· Advanced Cardiac MR Imaging of Ischemic Heart Disease http://radiographics.rsnajnls.org/cgi/content/full/21/4/1047
· Cardiac magnetic resonance with T2-weighted imaging improves detection of patients with acute coronary syndrome in the emergency department. Circulation. 2008;118(8):837-44.
· Combined assessment of myocardial perfusion and late gadolinium enhancement in patients after percutaneous coronary intervention or bypass grafts: a multicenter study of an integrated cardiovascular magnetic resonance protocol. Cardiovascular Imaging 2009 Nov;2(11):1292-300.
· Contrast-enhanced Cardiac MR Imaging in the Detection of Reduced Coronary Flow Velocity Reserve http://radiology.rsnajnls.org/cgi/content/full/243/2/377
· Diagnostic Performance of Stress Perfusion and Delayed-Enhancement MR Imaging in Patients with Coronary Artery Disease http://radiology.rsna.org/content/240/1/39.full
· Evaluation of acute coronary syndromes by cardiac magnetic resonance imaging. Top Magn Reson Imaging. 2008 Feb;19(1):25-32. Review.
· Multimodality imaging in the assessment of myocardial viability Heart Failure Reviews 2010
· Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability Circulation 2004
· Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart Circulation January 2002
· T2-weighted cardiovascular magnetic resonance imaging; J of MRI Volume 26, Issue 3, pages 452–459, Sept 2007
· Initial Clinical Experience With Regadenoson, a Novel Selective A2A Agonist for Pharmacologic Stress Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging http://content.onlinejacc.org/cgi/content/full/46/11/2069
·
Pharmacologic stress testing: New methods and
new agents http://www.springerlink.com/content/x01365m47227260k/fulltext.pdf
Lower Extremity MRA
· Anatomy of leg arteries http://gensurg.co.uk/ic%20-%20artery%20anatomy.htm
· MR Angiography in the Evaluation of Atherosclerotic Peripheral Vascular Disease http://radiology.rsnajnls.org/cgi/content/full/214/2/325
· MR Angiography of Lower Extremities at 3 T: Presurgical Planning of Fibular Free Flap Transfer for Facial Reconstruction http://www.ajronline.org/cgi/content/full/190/3/770
· Cardiac Tumors: Optimal Cardiac MR Sequences and Spectrum of Imaging Appearances (AJR August 2009)
· CT and MR Imaging of Primary Cardiac Malignancies Radiographics November 1999
· Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation
· Three-dimensional contrast-enhanced MR angiography of the thoraco-abdominal vessels. Magn Reson Imaging Clin N Am. 2005 May;13(2):359-80. Review.
· Contrast-enhanced MR Angiography of the Hand http://radiographics.rsnajnls.org/cgi/content/full/22/3/583
· MR Imaging of Aortic and Peripheral Vascular Disease (From the RSNA Refresher Courses)- October 2003 RadioGraphics, 23, S59-S78.
· Nonenhanced MR Angiography: State of the Art. http://radiology.rsnajnls.org/cgi/content/full/248/1/20
· Radial Artery Mapping for Coronary Artery Bypass Graft Placement http://radiology.rsnajnls.org/cgi/content/full/220/2/299
· Time-Resolved MR Angiography of the Central Veins of the Chest http://www.ajronline.org/cgi/content/full/191/5/1581
· Unenhanced Flow-Independent MR Venography by Using Signal Targeting Alternative Radiofrequency and Flow-Independent Relaxation Enhancement http://radiology.rsnajnls.org/cgi/content/full/250/1/236
· Differentiating Acute Myocardial Infarction from Myocarditis: Diagnostic Value of Early- and Delayed-Perfusion Cardiac MR Imaging Radiology Oct 2005.
· Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart Circulation 2002
· Assessment of left ventricular non-compaction in adults: side-by-side comparison of cardiac magnetic resonance imaging with echocardiography. Archives of Cardiovascular Diseases Volume 103, Issue 3, March 2010, Pages 150-159.
à Figure: Assessment of the two-layered structure and the non-compacted epicardial layer thickness/compacted epicardial layer thickness (NC/C) ratio in short-axis views by the three imaging methodologies. Red lines are non-compacted layers; yellow lines are compacted layers. CMR: cardiac magnetic resonance; Echo-2D: two-dimensional echocardiography.
· Isolated Left Ventricular Noncompaction UpToDate19.2
· Left Ventricular Non-Compaction Insights From Cardiovascular Magnetic Resonance Imaging J Am Coll Cardiol, 2005; 46:101-105
à RESULTS: Areas of non-compaction were common and occurred more frequently in all groups studied in apical and lateral, rather than in basal or septal, segments. A NC/C ratio of >2.3 in diastole distinguished pathological non-compaction, with values for sensitivity, specificity, and positive and negative predictions of 86%, 99%, 75%, and 99%, respectively.
à CONCLUSIONS: Left ventricular non-compaction is diagnosed accurately with CMR using the NC/C ratio in diastole.
· Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy European Radiology 2006
· The Role of Cardiovascular MRI in Heart Failure and the Cardiomyopathies MRI Clinics 2007
· Real-time cine MRI of ventricular septal motion: A novel approach to assess ventricular coupling Journal of MRI March 2005
· CT and MR Imaging of Pericardial Disease RadioGraphics October 2003
· Lesions of the Cardiophrenic Space: Findings at Cross-sectional Imaging Radiographics January 2007
· Recent role of imaging in the diagnosis of pericardial disease Current Cardiology Reports 2002
· Cardiovascular Applications of Phase-Contrast MRI http://www.ajronline.org/cgi/content/full/192/3/662
· Cardiovascular Flow Measurement with Phase-Contrast MR Imaging: Basic Facts and Implementation http://radiographics.rsna.org/content/22/3/651.full
à SVC and Inferior Vena Cava
o The encoding velocity for the first measurement or for flow measurement is 110 cm/sec. The usual velocity for peak velocity measurement is 50–80 cm/sec.
à Ascending Aorta
o The encoding velocity for the first measurement or for flow measurement is 200 cm/sec. The usual velocity for peak velocity measurement is 100–160 cm/sec.
à Main Pulmonary Artery
o The encoding velocity for the first measurement or for flow measurement is 180 cm/sec. The usual velocity for peak velocity measurement is 60–120 cm/sec.
à Right and Left Pulmonary Arteries
o The encoding velocity for the first measurement or for flow measurement is 200 cm/sec. The usual velocity for peak velocity measurement is 60–120 cm/sec.
· Quantification of Flow Dynamics in Congenital Heart Disease: Applications of Velocity-encoded Cine MR Imaging http://radiographics.rsna.org/content/22/4/895.full
· Assessment of Coronary Artery Disease Using Magnetic Resonance Coronary Angiography JACC September 2010
· Association between Signal Hyperintensity on T1-Weighted MR Imaging of Carotid Plaques and Ipsilateral Ischemic Events AJNR February 2007
· 3D Black-Blood Cardiac MR Coronary Vessel Wall Imaging Detects Positive Arterial Remodeling in Patients With Nonsignificant Coronary Artery Disease Circulation 2002
·
Carotid
Artery Atherosclerosis: Effect of Intensive Lipid Therapy on the Vasa
Vasorum—Evaluation by Using Dynamic Contrast-enhanced MR Imaging Radiology April 2011
· Characterization of hyperintense plaque with noncontrast T1W cardiac MR coronary plaque imaging: comp w/ CT & intravascular US JACC June 2009
· Coronary CT versus MR Angiography: The Role of MR Angiography Radiology February 2011
· Coronary Plaque Characterization by T1-Weighted Cardiac MRI JACC June 2009
· Delayed-Enhancement Cardiovascular Magnetic Resonance Coronary Artery Wall Imaging JACC 2007
· Identifying vulnerable carotid plaques by noninvasive imaging Neurology June 2008
· Imaging of atherosclerosis: magnetic resonance imaging European Heart Journal April 2011
· Imaging of the unstable plaque: how far have we got? European Heart Journal October 2009
· Moderate Carotid Artery Stenosis: MRI–depicted Intraplaque Hemorrhage Predicts Risk of Cerebrovascular Ischemic Events in Asymptomatic Men Radiology August 2009
· Noninvasive In Vivo Human Coronary Artery Lumen and Wall Imaging Using Black-Blood Magnetic Resonance Imaging Circulation 2000
· Noninvasive Visualization of Coronary Artery Endothelial Function in Healthy Subjects & Patients w/ Coronary Artery Disease JACC Nov 2010
· Serial Contrast-Enhanced Cardiac MRI Demonstrates Regression of Hyperenhancement Within the Coronary Artery Wall in Patients After Acute MI JACC May 2009
· Subclinical Coronary and Aortic Atherosclerosis Detected by MRI in Type 1 Diabetes With and Without Diabetic Nephropathy Circulation 2007
· The Vulnerable, or High-Risk, Atherosclerotic Plaque: Noninvasive MR Imaging for Characterization and Assessment Radiology July 2007
SHUNTS
· Assessment of Left-to-Right Intracardiac Shunting by Velocity-Encoded, Phase-Difference Magnetic Resonance Imaging http://www.circ.ahajournals.org/cgi/content/full/91/12/2955
· Cardiovascular Shunts: MR Imaging Evaluation http://radiographics.rsnajnls.org/cgi/content/full/23/suppl_1/S181
· Quantification of left-to-right shunting in adult congenital heart disease: phase-contrast cine MRI compared with invasive oximetry http://bjr.birjournals.org/cgi/content/full/82/977/386
o
Interventional closure or corrective surgery is
usually indicated in patients with a Qp/Qs ratio ≥1.5.
o For the calculation of pulmonary (Qp) and systemic (Qs) flow volumes, the cross-sectional areas of the pulmonary trunk and ascending aorta were drawn manually for each time frame on the magnitude images and transferred to the corresponding phase image.
o Shunt volumes for left-to-right shunts in ASD and VSD were calculated by the following formula:
§ Left-to-right shunt (%) = (Qp – Qs)/Qp
o Shunt volumes in the case of PDA were calculated by the following formula:
§ (Qs – Qp)/Qs
· Imaging Assessment of Thoracic Outlet Syndrome Radiographics November 2006
VALVES
· Cardiovascular Magnetic Resonance Imaging for Valvular Heart Disease http://circ.ahajournals.org/cgi/content/full/119/3/468
· Cardiac MR Assessment of Aortic Regurgitation: Holodiastolic Flow Reversal in the Descending Aorta Helps Stratify Severity Radiology July 2011
· Detection and Quantification of Valvular Heart Disease with Dynamic Cardiac MR Imaging http://radiographics.rsna.org/content/20/5/1279.full
· Evaluation of Cardiac Valvular Disease with MR Imaging: Qualitative and Quantitative Techniques http://radiographics.rsnajnls.org/cgi/content/full/23/1/e9
à
In general, patients with stenotic lesions can
be monitored clinically until symptoms appear. On the other hand, patients with
regurgitant lesions require careful monitoring for signs of left ventricular
(LV) dysfunction and may require surgery even while asymptomatic.
à These measurements are performed most often for aortic insufficiency, and in this case slice positioning is fairly important: the phase contrast slice should be positioned above the valve at the level of the coronary ostia (Fig 11). Sections positioned in a more distal location (for instance at the level of the right pulmonary artery) tend to underestimate the amount of regurgitant flow
à Quantification of stenotic valves with either echocardiography or MR imaging involves measuring peak and average velocities across the valve and converting these into pressure gradients with the modified Bernoulli equation: Δ P = 4vmax2 , where P is pressure in millimeters of mercury and v is velocity in meters per second. The technique for measurement of peak velocity is slightly different from that used for flow measurement in regurgitant valves. Several phase-contrast sections are oriented perpendicular to the flow jet rather than perpendicular to the vessel; this assures that the error in velocity caused by oblique positioning is minimized.
· Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve http://circ.ahajournals.org/cgi/content/full/108/10_suppl_1/II-291
· Mitral Valve Prolapse: Evaluation With ECG-Gated Cardiac CT Angiography http://www.ajronline.org/cgi/content/full/194/3/579
· Planimetry of Mitral Valve Stenosis by Magnetic Resonance Imaging http://content.onlinejacc.org/cgi/content/full/45/12/2048
· Utility of Balanced Steady-State Free Precession MR Venography in the Diagnosis of Lower Extremity Deep Venous Thrombosis http://www.ajronline.org/cgi/content/full/194/5/1357