Elsevier

The Lancet

Volume 363, Issue 9427, 26 June 2004, Pages 2162-2171
The Lancet

Review
Role of MRI in clinical cardiology

https://doi.org/10.1016/S0140-6736(04)16509-4Get rights and content

Summary

Rapid progress has been made in cardiac MRI (CMRI) over the past decade, which has firmly established it as a reliable and clinically important technique for assessment of cardiac structure, function, perfusion, and myocardial viability. Its versatility and accuracy is unmatched by any other individual imaging modality. CMRI is non-invasive and has high spatial resolution and avoids use of potentially nephrotoxic contrast agent or radiation. It has been extensively studied against other established non-invasive imaging modalities and has been shown to be superior in many scenarios, particularly with respect to assessment of cardiac and great vessel morphology and left ventricular function. Furthermore, its clinical use continues to expand with increasing experience and proliferation of CMRI centres. As worldwide prevalence of cardiovascular disease continues to rise, CMRI provides opportunity for improved and cost-effective non-invasive assessment. Continued progress in CMRI technology promises to further widen its clinical application in coronary imaging, myocardial perfusion, comprehensive assessment of valves, and plaque characterisation.

Section snippets

The technique

MRI is based on the principle of nuclear magnetic resonance and has intrinsic attributes well suited for cardiac imaging. It is a tomographic technique that can acquire images in virtually any orientation.

Images are derived from signals produced by protons (hydrogen nuclei), which are present in abundance because the human body consists mainly of water. The proton behaves like a small magnet when placed in a magnetic field: it aligns with the field and precesses with a given frequency that

Assessment of morphology and function

The clinical role of CMRI is well established for morphological assessment of complex cardiac anomalies and great vessels. This role is partly attributed to the large field of view of CMRI, its unlimited scanning planes, and good tissue contrast. Furthermore, CMRI is a precise and highly reproducible method for measurement of right ventricular and left ventricular systolic and diastolic function, and mass.7, 8, 9, 10

In echocardiography, mass and volumes are derived from a limited

Aortic disease

Findings of several studies have established the place of CMRI in the screening, diagnosis, and follow-up of aortic pathology. The large field of view, flexible imaging planes, and ability to image surrounding structures make CMRI an ideal method for diagnosis of diseases of the aorta.14, 15 In a study comparing transoesophageal echocardiography, CT, transthoracic echocardiography, and CMRI, CMRI was shown to have equal if not greater sensitivity and superior specificity over other imaging

Valvular heart disease

Echocardiography and catheterisation remain the mainstay of assessment for valvular heart disease, despite their limitations. However, CMRI is rapidly gaining acceptance as an accurate and highly reproducible method for best assessment of structural and functional valvular variables. Although direct visualisation of valve leaflets is difficult because of limited temporal resolution, new techniques are showing promise (figure 2).29 Specificity, sensitivity, and diagnostic accuracy of cine

Congenital heart disease

Management of congenital heart diseases depends on precise definition of cardiac morphology and altered haemodynamics. Echocardiography and cardiac catheterisation are the standard procedures used to assess these variables. However, because CMRI can completely assess cardiac and vascular morphology, venoatrial connections, and visceral situs and extracardiac abnormalities, it is effective in anatomic assessment of complex congenital heart defects.38, 39 Although cardiac catheterisation cannot

Cardiomyopathies

CMRI is well established in diagnosis and follow-up of Cardiomyopathies. It can characterise tissue and provide good morphological definition. Also, accurate assessment of function aids diagnosis and prognosis of various types of Cardiomyopathies.

Although echocardiography gives adequate morphological and functional data, CMRI is especially valuable in diagnosis of rare forms and atypical patterns. Moreover, since it can accurately assess left ventricular mass and distribution, CMRI is valuable

Cardiac tumours

Magnetic resonance has an increasing part to play in management of cardiac neoplasms. Apart from atrial myxomas and primary valvular tumours, for which echocardiography is adequate for diagnosis and planning of treatment, CMRI provides additional anatomical information within the heart and evidence of extension into extracardiac structures.86, 87

Selective sequences—such as fat-suppression techniques—can be used to further characterise tumours such as lipomas or to accurately define extent of

Ischaemic heart disease

Evaluation of ischaemic heart disease includes not only definition of coronary anatomy but also assessment of ventricular morphology and function, myocardial perfusion and viability, and coronary flow reserve.

Pericardial disease

CMRI is the investigation of choice in diagnosis of pericardial disease. On Tl-weighted spin-echo imaging, pericardium appears as a thin low-signal band because of its fibrous content, bordered by high signal intensities of epicardial and pericardial fat. Pericardial thickness of up to 4 mm is judged normal.123

Congenital pericardial defects, tumours, effusions, and constrictive pericarditis are diagnosed precisely with CMRI. Localised pericardial thickening and encysted pericardial effusions

Interventional MRI

Ultrafast imaging techniques are being investigated to extend the potential role of CMRI from diagnostic use to an alternative real-time technique to conventional fluoroscopy. Magnetic resonance fluoroscopy is being investigated in interventional cardiology and related areas with transcatheter techniques, because CMRI has the advantage of three-dimensional imaging with high spatial resolution and good soft-tissue contrast. Furthermore, it might provide pathological information such as plaque

Future

Introduction of parallel acquisition methods that allow simultaneous generation of multiple image sets will make near real-time high-resolution MRI possible.131, 132 Several other pulse sequences, such as spiral imaging, multiecho imaging, wavelet-encoded data acquisition, keyhole imaging, etc, achieve faster image acquisition times with some compromise in spatial resolution, but show promise in magnetic resonance fluoroscopy.133, 134, 135, 136

CMRI is a potential non-invasive imaging method for

Search strategy and selection criteria

We did an extensive search for original articles and reviews from 1987 to March 15, 2003. We used EMBASE and PubMed in addition to manual journal search. The keyword “cardiac magnetic resonance imaging”, with a combination of subtitles such as “myocardial viability” and other related terms, were used for the search. We included major studies, studies published from institutions specialising in specific conditions, and important review articles.

Conflict of interest statement

GC and KS declare no

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