Abstract
Magnetic resonance imaging (MRI) has become increasingly accessible in cardiovascular medicine and, in many respects, is considered the non-invasive gold standard for the anatomical, functional and histological assessment of the heart and vessels. In particular, specific sequences and protocols have been developed to investigate in depth almost all ischaemic, nonischaemic, valvular, vascular and congenital heart diseases, and are grouped under the term of cardiovascular magnetic resonance (CMR). The principle of MRI relies on the excitation and interaction between the hydrogen nuclei of biological tissues with three different magnetic fields (static, gradient and radiofrequency) applied in a specific temporal sequence during the scan. Many different sequences can be run using diverse parameters, each designed for a specific purpose: cine gradient-echo and cine steady-state free precession sequences allow anatomical and functional assessment of cardiac chambers; fast spin-echo sequences allow tissue characterization with different T1, T2 and proton-density weighting, in order to differentiate tissues according to their biochemical composition; post-contrast first-pass sequences permit to visualize and quantify myocardial perfusion; post-contrast late enhancement sequences are designed to assess the presence, extent and distribution of scar within the myocardium. Recently, native T1 mapping, T2/T2* mapping and extracellular volume mapping have been introduced as quantitative tools, further improving the diagnostic and prognostic usefulness of CMR. The recognized clinical value and complexity of the provided information impose CMR as a fundamental diagnostic tool in cardiology, after first-level examinations, including clinical, biohumoral, electrocardiography and echocardiography, have been applied. This introductory chapter will provide a brief overview of the physics of MRI, the most common CMR sequences, their clinical applications and the most important limitations and contraindications of a CMR exam.
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References
Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson. 2020;22:17. https://doi.org/10.1186/s12968-020-00607-1.
Aquaro GD, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, Di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Pontone G. Clinical recommendations of cardiac magnetic resonance, part I: ischemic and valvular heart disease: a position paper of the working group “Applicazioni della Risonanza Magnetica” of the Italian Society of Cardiology. J Cardiovasc Med. 2017;18:197–208. https://doi.org/10.2459/JCM.0000000000000498.
Pontone G, Di Bella G, Silvia C, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, Di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Aquaro GD. Clinical recommendations of cardiac magnetic resonance, part II: inflammatory and congenital heart disease, cardiomyopathies and cardiac tumors: a position paper of the working group “Applicazioni della Risonanza Magnetica” of the Italian Society of Cardiology. J Cardiovasc Med. 2017;18:209–22. https://doi.org/10.2459/JCM.0000000000000499.
Ridgway JP. Cardiovascular magnetic resonance physics for clinicians: part I. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson. 2010;12:71. https://doi.org/10.1186/1532-429X-12-71.
Barison A, Baritussio A, Cipriani A, De Lazzari M, Aquaro GD, Guaricci AI, Pica S, Pontone G, Todiere G, Indolfi C, Dellegrottaglie S. Cardiovascular magnetic resonance: what clinicians should know about safety and contraindications. Int J Cardiol. 2021;331:322–8. https://doi.org/10.1016/J.IJCARD.2021.02.003.
Barison A, Aimo A, Todiere G, Grigoratos C, Aquaro GD, Emdin M. Cardiovascular magnetic resonance for the diagnosis and management of heart failure with preserved ejection fraction. Heart Fail Rev. 2020;2020:1–15. https://doi.org/10.1007/S10741-020-09998-W.
Levine GN, Gomes AS, Arai AE, Bluemke DA, Flamm SD, Kanal E, Manning WJ, Martin ET, Smith JM, Wilke N, Shellock FS. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American heart association scientific statement from the committee on diagnostic and interventional cardiac catheterization, council on clinical cardiology, and the council on cardiovascular radiology and intervention. Circulation. 2007;116:2878–91. https://doi.org/10.1161/CIRCULATIONAHA.107.187256.
CMR Safety—Society for Cardiovascular Magnetic Resonance (SCMR). (n.d.). https://scmr.org/general/custom.asp?page=CMRsafety. Accessed 15 Jan 2021.
F.G. Shellock, MRI safety home, (n.d.). http://www.mrisafety.com/. Accessed 15 Jan 2021.
Blaschke F, Lacour P, Walter T, Wutzler A, Huemer M, Parwani A, Attanasio P, Boldt LH, Markowski M, Denecke T, Haverkamp W. Cardiovascular magnetic resonance imaging in patients with an implantable loop recorder. Ann Noninvasive Electrocardiol. 2016;21:319–24. https://doi.org/10.1111/anec.12333.
Napp AE, Enders J, Roehle R, Diederichs G, Rief M, Zimmermann E, Martus P, Dewey M. Analysis and prediction of claustrophobia during MR imaging with the claustrophobia questionnaire: an observational prospective 18-month single-center study of 6500 patients. Radiology. 2017;283:148–57. https://doi.org/10.1148/radiol.2016160476.
Eshed I, Althoff CE, Hamm B, Hermann KGA. Claustrophobia and premature termination of magnetic resonance imaging examinations. J Magn Reson Imaging. 2007;26:401–4. https://doi.org/10.1002/jmri.21012.
Nacif MS, Zavodni A, Kawel N, Choi EY, Lima JAC, Bluemke DA. Cardiac magnetic resonance imaging and its electrocardiographs (ECG): tips and tricks. Int J Card Imaging. 2012;28:1465–75. https://doi.org/10.1007/s10554-011-9957-4.
Raphael CE, Vassiliou V, Alpendurada F, Prasad SK, Pennell DJ, Mohiaddin RH. Clinical value of cardiovascular magnetic resonance in patients with MR-conditional pacemakers. Eur Heart J Cardiovasc Imaging. 2016;17:1178–85. https://doi.org/10.1093/ehjci/jev305.
Hilbert S, Jahnke C, Loebe S, Oebel S, Weber A, Spampinato R, Richter S, Doering M, Bollmann A, Sommer P, Hindricks G, Paetsch I. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality. Eur Heart J Cardiovasc Imaging. 2018;19:1051–61. https://doi.org/10.1093/ehjci/jex243.
Ibrahim E-SH, Runge M, Stojanovska J, Agarwal P, Ghadimi-Mahani M, Attili A, Chenevert T, den Harder C, Bogun F. Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices, world. J Radiol. 2018;10:100–7. https://doi.org/10.4329/wjr.v10.i9.100.
ACR Manual On Contrast Media. 2020. ACR Committee on Drugs and Contrast Media, 2020. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Accessed 28 Apr 2020.
Wang Y, Alkasab TK, Narin O, Nazarian RM, Kaewlai R, Kay J, Abujudeh HH. Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines. Radiology. 2011;260:105–11. https://doi.org/10.1148/radiol.11102340.
Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of nephrogenic systemic fibrosis in patients with stage 4 or 5 chronic kidney disease receiving a group II gadolinium-based contrast agent: a systematic review and meta-analysis. JAMA Intern Med. 2020;180:223–30. https://doi.org/10.1001/jamainternmed.2019.5284.
Weinreb JC, Rodby RA, Yee J, Wang CL, Fine D, McDonald RJ, Perazella MA, Dillman JR, Davenport MS. Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology. 2021;298:28–35. https://doi.org/10.1148/radiol.2020202903.
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Barison, A., Martini, N., Dellegrottaglie, S., Pontone, G. (2023). Introduction to Cardiac MRI. In: Barison, A., Dellegrottaglie, S., Pontone, G., Indolfi, C. (eds) Case-based Atlas of Cardiovascular Magnetic Resonance. Springer, Cham. https://doi.org/10.1007/978-3-031-32593-9_1
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DOI: https://doi.org/10.1007/978-3-031-32593-9_1
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