Contents

Search

cardiac magnetic resonance imaging (CMR imaging)

Indications: 1) congenital heart disease - Fabry disease [1] 2) aortic disease 3) myocardial viabilty 4) myocardial disease a) infiltrative myocarditis - cardiac amyloidosis [1] b) hypertrophic cardiomyopathy c) dilated cardiomyopathy - hemochromatosis [1] d) myocarditis - sarcoidosis [1] e) myocardial fibrosis [1] - endomyocardial fibrosis f) right ventricular cardiomyopathy 5) pericardial disease [1] 6) quantitation of LV mass & LV function 7) assessment of chronic mitral regurgitation [1] 8) evaluation of coronary artery disease [5] * late gadolinium enhancement on cardiac magnetic resonance imaging is associated with poor prognosis in myocarditis [4] * combined assessment of inducible myocardial ischemia & late gadolinium enhancement by stress cardiac magnetic resonance imaging is useful for diagnosis & risk stratification in patients with suspected or known coronary artery disease [5] Advantages: 1) high-resolution tomographic imaging & blood flow data 2) quantitative right ventricular volumes & ejection fraction 3) no ionizing radiation or contrast agents 4) enables 3-D reconstruction of aortic & coronary artery anatomy 5) gadolinium-enhanced images accurately identify viable & infarcted myocardium 6) identifies anomalous coronary arteries 7) outperforms myocardial perfusion & viability scintigraphy [2] Disadvantages: 1) limited availability & expertise 2) some patients experience claustrophobia 3) may not be appropriate for patients with pacemaker, ICD, or other implanted devices 4) gadolinium is contraindicated in patients with renal failure 5) sinus rhythm & slower heart rate needed for image quality [1]

General

MRI of chest; MRI of thorax cardiac imaging

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2022
  2. Greenwood JP et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): A prospective trial. Lancet 2012 Feb 4; 379:453 PMID: 22196944
  3. Hundley WG, Bluemke DA, Finn JP et al ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010 Jun 8;55(23):2614-62 PMID: 20513610
  4. Aquaro GD, Perfetti M, Camastra G et al. Cardiac MR with late gadolinium enhancement in acute myocarditis with preserved systolic function: ITAMY study. J Am Coll Cardiol 2017 Oct 17; 70:1977 PMID: 29025554 - Grani C, Eichhorn C, Biere L et al. Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. J Am Coll Cardiol 2017 Oct 17; 70:1964. (http://dx.doi.org/10.1016/j.jacc.2017.08.050) PMID: 29025553 - Mahrholdt H. Greulich S. Prognosis in myocarditis: Better late than (n)ever! J Am Coll Cardiol 2017 Oct 17; 70:1988 PMID: 29025555
  5. Ricci F, Khanji MY, Bisaccia G et al Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease. A Systematic Review and Meta-analysis. JAMA Cardiol. 2023;8(7):662-673 PMID: 37285143 PMCID: PMC10248816 (available on 2024-06-07) https://jamanetwork.com/journals/jamacardiology/fullarticle/2805949